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CME Released: 6/9/2008
Valid for credit through: 6/9/2009, 11:59 PM EST
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June 9, 2008 — The Finnish Diabetes Risk Score (FINDRISC) was effective in identifying high-risk groups that would benefit from intensive lifestyle intervention to prevent type 2 diabetes, according to the results of a randomized controlled trial reported in the May issue of Diabetes Care.
"Intensive lifestyle intervention significantly reduced diabetes incidence among the participants in the Finnish Diabetes Prevention Study (DPS)," write Jaana Lindström, PhD, from the National Public Health Institute in Helsinki, Finland, and colleagues from the Finnish DPS Group. "We investigated whether and to what extent risk factors for type 2 diabetes and other baseline characteristics of the study participants modified the effectiveness of the lifestyle intervention."
In this study, overweight, middle-aged volunteers with impaired glucose tolerance were randomized to an intensive lifestyle intervention (n = 265) or to a control group (n =257) for a median of 4 years, during which annual oral glucose tolerance testing determined diabetes status.
Incidence rates of diabetes and hazard ratios (HRs) for the intervention vs the control group were calculated by sex and baseline tertiles of age, body mass index (BMI), waist circumference, plasma glucose concentration at fasting and 2 hours after a glucose load, fasting serum insulin and insulin resistance index, and categories of composite baseline FINDRISC. The investigators determined interactions between the intervention assignment and baseline risk factors on the risk for diabetes.
Groups in which the intervention was most effective were the oldest individuals (HRs 0.77, 0.49, and 0.36 by increasing age tertiles, respectively; P for interaction = .0130) and those with high baseline FINDRISC (HRs 1.09, 0.84, 0.34, and 0.22 by increasing risk score category, respectively; P for interaction = .0400). Other baseline characteristics or risk factors did not modify the effect of the intervention on the risk for diabetes.
"The FINDRISC may be useful in identifying high-risk groups most likely to benefit from intensive lifestyle intervention to prevent type 2 diabetes," the study authors write.
Limitations of this study include careful selection of DPS participants, limiting generalizability to other populations with differing risk profiles.
"Intensive lifestyle intervention in individuals with IGT [impaired glucose tolerance] was most effective among those with higher baseline age or a high FINDRISC," the study authors write. “To improve cost-effectiveness, the FINDRISC could be used to identify target groups for lifestyle intervention to prevent type 2 diabetes."
The DPS study has been supported by the Academy of Finland, the Juho Vainio Foundation, Ministry of Education, the Novo Nordisk Foundation, the Yrjö Jahnsson Foundation, and the Finnish Diabetes Research Foundation, and by competitive research funding from Tampere, Kuopio, and Oulu University Hospitals. The costs of publication of this article were defrayed in part by the payment of page charges, mandating that it must therefore be hereby marked "advertisement" solely to indicate this fact.
Diabetes Care. 2008;31:857-862.
Although randomized controlled trials have shown that lifestyle intervention in individuals with impaired glucose tolerance may prevent or postpone progression to overt type 2 diabetes, the effect of lifestyle intervention varies among individuals. Risk reduction in diabetes incidence requires compliance with the lifestyle intervention goals.
It has not previously been determined whether baseline risk factors for type 2 diabetes or other characteristics could modify the effectiveness of lifestyle intervention to reduce diabetes risk. Identifying individuals most likely to benefit from lifestyle intervention could direct intensified actions to these groups, decreasing the number needed to treat while reducing costs.