Prevention of T2D

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There are numerous studies giving evidence that weight loss in obese subjects and particularly in obese subjects with impaired glucose tolerance (IGT) may prevent development of T2D. In a small well-performed study in Malmo Sweden [4] overweight men with IGT were enrolled in a 5-year intervention program emphasizing a low-calorie diet and physical training. At the 5-year follow-up participants showed a mean weight loss of 2.3 kg whereas control subjects showed a mean weight gain of 0.5 kg. In the intervention group 75.8% showed improved glucose tolerance whereas 10.6% progressed to T2D. In contrast, in the control group 67.1% showed deterioration in glucose tolerance and 28.6% progressed to T2D.

In agreement with this study in large diabetes prevention trials with lifestyle changes, including calorie restriction and encouragement to increase physical activity, the incidence of diabetes was reduced in the lifestyle intervention groups.

In the Da Qing IGT and Diabetes Study [5] the cumulative incidence of diabetes at 6 years in subjects with IGT at baseline was 67.7% in the control group. In the diet, exercise, and diet-plus-exercise intervention groups the risk of developing diabetes compared to the control group was reduced by 31, 46 and 42%, respectively.

In the Finland Study [6], the effect of the intervention on the incidence of diabetes was most pronounced among subjects who made comprehensive changes in lifestyle. Compared to subjects undergoing typical care (control group) in those with weight loss the incidence of diabetes was reduced by more than 50%.

In the Diabetes Prevention Program [7] the incidence of diabetes in persons at risk after a mean follow-up of 2.8 years was 11.0 cases per 100 person-years in the placebo group but only 4.8 in the lifestyle group.

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