Research articleReduction in Incidence of Type 2 Diabetes by Lifestyle Intervention in a Middle Eastern Community
Introduction
Type 2 diabetes has reached epidemic levels in most populations. The epidemiologic evidence1 suggests that unless effective preventive measures are implemented, the prevalence of this disease will continue to rise globally. It is estimated2 that developing countries in Asia, and in the Middle East in particular, will have the largest increases in the prevalence of diabetes by 2030. The prevalence of Type 2 diabetes is reported3 to be more than 14% in Tehran, Iran, with an estimated incidence4 of new cases in about 1% of the population per year.
Randomized interventional studies in high-risk populations5, 6, 7, 8 have demonstrated that weight-loss and exercise programs can reduce risk factors associated with diabetes. A meaningful decrease in the prevalence of diabetes can be achieved mainly by changing the underlying contributing factors (e.g., obesity and/or sedentary lifestyle) in the general population.9 As far as we know, there is limited evidence about application of community-based interventions for primary prevention of Type 2 diabetes and their direct effect on diabetes incidence is relatively unknown.10 The Tehran Lipid and Glucose Study (TLGS) has provided a unique opportunity to address this issue through a large-scale community-based prospective trial on a representative sample of residents of District 13 of Tehran. The purpose of the current study was to assess whether lifestyle interventions could prevent or delay the onset of Type 2 diabetes in the aforementioned participants.
Section snippets
Study Population
The rationale and design of the TLGS has been published elsewhere.11 The TLGS had two major components: Phase 1 was a cross-sectional prevalence study of noncommunicable diseases (NCDs) and their associated risk factors implemented from 1999 to 2001; Phase 2 was a prospective follow-up study in which NCD risk factors were measured approximately every 3 years.
The current study used data from the first follow-up visit, which took place from 2002 to 2005. A cluster-controlled trial, nested within
Results
Baseline characteristics of the individuals who participated or were lost to follow-up are presented in Table 1. The mean age and BMI of the studied population was 43±13 years and 26.8 kg/m2, respectively; 40% were men. The risk profiles of the intervention and control groups were comparable except for the prevalence of smoking and the level of physical activity, which were lower in the intervention group. Comparison of the retained and drop-out samples showed that respondents of both control
Discussion
This nonrandomized study demonstrated that a general lifestyle modification program was effective in reducing major modifiable diabetes risk factors, had a favorable effect on weight reduction in overweight and obese individuals, and resulted in a 65% reduction in the incidence of diabetes in men and women living in the city of Tehran. The findings are in accordance with those of other studies, suggesting that Type 2 diabetes can be postponed or prevented by lifestyle intervention. Moreover, to
Conclusion
The present study demonstrated that a community-based prevention program not only can slow down the trend toward greater prevalence of cardiovascular risk factors in the general population, and in some cases even reduce them, contributing to overall health, but also can substantially delay the onset of Type 2 diabetes. Taking logical steps toward changing the lifestyle of the population via community-based programs can efficiently decrease the burden of noncommunicable diseases in those
References (26)
- et al.
Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males
Diabetes Res Clin Pract
(2005) - et al.
Effect of 5-year community intervention Hartslag Limburg on cardiovascular risk factors
Am J Prev Med
(2006) - et al.
The prospective association of general and central obesity variables with incident type 2 diabetes in adults, Tehran lipid and glucose study
Diabetes Res Clin Pract
(2007) - et al.
International Diabetes Federation: a consensus on type 2 diabetes prevention
Diabet Med
(2007) - et al.
Global prevalence of diabetes: estimates for the year 2000 and projections for 2030
Diabetes Care
(2004) - et al.
High prevalence of undiagnosed diabetes and abnormal glucose tolerance in the Iranian urban population: Tehran Lipid and Glucose Study
BMC Public Health
(2008) - et al.
Population-based incidence of Type 2 diabetes and its associated risk factors: results from a six-year cohort study in Iran
BMC Public Health
(2009) - et al.
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
N Engl J Med
(2002) - et al.
Effects of diet and exercise in preventing NIDDM in people with impaired glucose toleranceThe Da Qing IGT and Diabetes Study
Diabetes Care
(1997) - et al.
The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1)
Diabetologia
(2006)