Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study
Open accessAbstract
Background Lifestyle interventions can delay the onset of type 2 diabetes in people with impaired glucose tolerance, but whether this leads subsequently to fewer complications or to increased longevity is uncertain. We aimed to assess the long-term effects of lifestyle interventions in people with impaired glucose tolerance on the incidence of diabetes, its complications, and mortality.Methods The original study was a cluster randomised trial, started in 1986, in which 33 clinics in Da Qing, China, were randomly assigned to either be a control clinic or provide one of three interventions (diet, exercise, or diet plus exercise) for 6 years for 577 adults with impaired glucose tolerance who usually receive their medical care from the clinics. Subsequently, participants were followed for up to 30 years to assess the effects of intervention on the incidence of diabetes, cardiovascular disease events, composite microvascular complications, cardiovascular disease death, all-cause mortality, and life expectancy.Findings Of the 577 participants, 438 were assigned to an intervention group and 138 to the control group (one refused baseline examination). After 30 years of follow-up, 540 (94%) of 576 participants were assessed for outcomes (135 in the control group, 405 in the intervention group). During the 30-year follow-up, compared with control, the combined intervention group had a median delay in diabetes onset of 3·96 years (95% CI 1·25 to 6·67; p=0·0042), fewer cardiovascular disease events (hazard ratio 0·74, 95% CI 0·59-0·92; p=0·0060), a lower incidence of microvascular complications (0·65, 0·45-0·95; p=0·025), fewer cardiovascular disease deaths (0·67, 0·48-0·94; p=0·022), fewer all-cause deaths (0·74, 0·61-0·89; p=0·0015), and an average increase in life expectancy of 1·44 years (95% CI 0·20-2·68; p=0·023).Interpretation Lifestyle intervention in people with impaired glucose tolerance delayed the onset of type 2 diabetes and reduced the incidence of cardiovascular events, microvascular complications, and cardiovascular and all-cause mortality, and increased life expectancy. These findings provide strong justification to continue to implement and expand the use of such interventions to curb the global epidemic of type 2 diabetes and its consequences.Funding US Centers for Disease Control and Prevention, WHO, Chinese Center for Disease Control and Prevention, World Bank, Ministry of Public Health of the People's Republic of China, Da Qing First Hospital, China-Japan Friendship Hospital, and National Center for Cardiovascular Diseases & Fuwai Hospital.
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Weight loss was a major contributor to the reduction in diabetes incidence in the ILS and metformin groups.
“Weight loss was a major contributor to the reduction in diabetes incidence in the ILS and metformin groups.17, 18”
From Long-term effects and effect heterogeneity of lifestyle and metformin interventions on type 2 diabetes incidence over 21 years in the US Diabetes Prevention Program randomised clinical trial (2025) · cites this paper as [17]
The Discussion (page unavailable) reports that investigators in the Diabetes Prevention Program and Finnish Diabetes Prevention Study considered weight loss important in reducing diabetes incidence, supporting the lifestyle-intervention portion of the claim. It does not say weight loss was a major contributor in a metformin group; for the Da Qing intervention, it instead points mainly to dietary changes and physical activity rather than weight loss. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThis can reduce long-term complications and may extend life expectancy.
“This can reduce long-term complications and may extend life expectancy [13].”
From Assessing the Effectiveness of Digital Health Behavior Strategies on Type 2 Diabetes Management: Systematic Review and Network Meta-Analysis (2025) · cites this paper as [13]
Lifestyle changes that slow, halt, or reverse type 2 diabetes can lead to fewer long-term complications and probably a prolonged life expectancy.
“This can lead to fewer long-term complications and probably a prolonged life expectancy [4].”
From Long-term Weight Loss in a Primary Care-Anchored eHealth Lifestyle Coaching Program: Randomized Controlled Trial (2022) · cites this paper as [4]
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“This can reduce long-term complications and may extend life expectancy [13].”
Self-citation
- Authors
- Gong, Q., Zhang, P., Wang, J., Ma, J., An, Y., Chen, Y., Zhang, B., Feng, X., Li, H., Chen, X., Cheng, Y. J., Gregg, E. W., Hu, Y., Bennett, P. H., Li, G., Qian, X., Zhang, L., Hui, Y., He, S., Wang, X., Thompson, T. J., Gerzoff, R. B., Liu, P., Jiang, Y., Hu, Z., Wang, J., Jiang, X., Zhang, J., Xi, R., Pang, C., Li, C., Hu, X., Yang, W., An, Z., Sun, X., Chen, C., Gang, Y., Liu, J., Xiao, J., Cao, H., Zheng, H., Zhang, H., Li, H., Hong, J., Liu, X., Zhao, F., Wang, W., Chen, B., Howard, B. V., Engelgau, M. M., & Roglic, G.
- Affiliations
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Centers for Disease Control and Prevention (US)
- Daqing Oilfield General Hospital (CN)
- Chinese Center For Disease Control and Prevention (CN)
- China-Japan Friendship Hospital (CN)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Corresponding author
- Li, Guangwei
- ORCID
- Gong, Qiuhong
- Zhang, Ping
- Wang, Jinping
- Ma, Jixiang
- Chen, Yanyan
- Zhang, Bo
- Feng, Xinxing
- Li, Hui
- Chen, Xiaoping
- Cheng, Yiling J
- Gregg, Edward W
- Hu, Yinghua
- Bennett, Peter H
- Li, Guangwei
- Qian, Xin
- Zhang, Lihong
- Wang, Xuan
- Thompson, Theodore J.
- Gerzoff, Robert B.
- Hu, Xiuying
- Yang, Wenying
- Chen, Chuan
- Liu, Juan
- Xiao, Jianzhong
- Cao, Huibi
- Zheng, Hui
- Zhang, Hui
- Li, Hongliang
- Liu, Xueli
- Wang, Wenjuan
- Chen, Bo
- Howard, Barbara V.
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 7
- Issue
- 6
- Pages
- 452-461
- ISSN
- 2213-8587 (ISSN-L)
- PMC
- PMC8172050
- OpenAlex
- W2940974223
- Cited by
- 615
- References
- 28
- Citations by year
- 2026: 60 · 2025: 102 · 2024: 124 · 2023: 88 · 2022: 91 · 2021: 63 · 2020: 63 · 2019: 22
- FWCI
- 48.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Spiral (Imperial College London) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institutes of Health (CC999999)
- Centers for Disease Control and Prevention (U19GH000636)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- impaired glucose tolerance, lifestyle intervention, type 2 diabetes prevention, diet and exercise, cardiovascular disease, microvascular complications, cardiovascular mortality, all-cause mortality, life expectancy
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, China, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Life Expectancy, Male, Middle Aged, Incidence, Glucose Intolerance, Risk Reduction Behavior
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