A lifestyle intervention in primary care prevents deterioration of insulin resistance in patients with impaired glucose tolerance: a randomised controlled trial
Abstract
AIMS: We hypothesised that the expected increase in insulin resistance over three years' time in individuals with impaired glucose tolerance (IGT) and/or impaired fasting glucose could be attenuated by an intervention with focus on physical activity in ordinary primary care. METHODS: We conducted a randomised controlled trial with 96 participants over three years. Examination of the participants included anthropometric measures, blood pressure, body weight and height, blood samples, an oral glucose tolerance test, and questionnaires about diet and lifestyle. The study subjects were randomised to either an intense intervention with information, group sessions, referral to physical activity and a step-counter ( n = 31), a less intense intervention without the group sessions ( n = 35), or care as usual group (CAUG) ( n = 30). Differences between the groups were analysed with general linear models adjusted for age, gender, baseline values and time in the intervention. RESULTS: Individual insulin resistance increased in the CAUG. Due to having a similar effect, we combined the two intervention groups into a combined intervention group (CIG; n = 66) in the analyses. In individuals with IGT, the increase in the homeostatic model assessment-insulin resistance differed significantly between those in the CAUG and the CIG (Δ = 0.8; CI: 0.1-1.6; p = 0.034). Likewise, diastolic blood pressure decreased more in the CIG than in the CAUG (Δ = 5.1; CI: 0.1-10.0; p = 0.047). A total of 17 individuals developed Type 2 diabetes, 23% were in the CIG and 33% in the CAUG; so there was a 32% reduced risk in the intervention group. CONCLUSIONS: A lifestyle intervention focused on physical activity is feasible in ordinary primary care and prevents deterioration in insulin sensitivity in individuals with IGT over a three-year period.
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In the comparison of physical activity versus standard treatment, 27%, 43% and 29% of participants in the physical activity group experienced worse, unchanged and better health-related quality of life, respectively, compared with 35%, 43% and 22% in the standard treatment group (Hellgren 2016).
“27%, 43% and 29% of participants in the physical activity group experienced worse, unchanged and better health-related quality of lif e, respectively (Hellgren 2016 -data provided by trial authors) 35%, 43% and 22% in the standard treatm ent group experienced worse, unchanged and better health-related quality of lif e, respectively (Hellgren 2016 -data provided by trial authors)”
From Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus (2017) · cites this paper as Hellgren 2016
Only four investigators (33%) of the included trials either just confirmed a question or provided additional data that could be implemented for the 'Risk of bias' assessment or the meta-analyses of outcomes.
“Unfortunately only four investigators (33%) of the included trials either just confirmed a question or provided additional data that could be implemented for the 'Risk of bias' assessment or the meta-analyses of outcomes (EDIPS 2009; Hellgren 2016; IDPP 2006; PODOSA 2014).”
From Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus (2017) · cites this paper as Hellgren 2016
Only one trial was classified as having low risk of bias for selective outcome reporting.
“Only one trial was classified as having low risk of bias for selective outcome reporting (Hellgren 2016).”
From Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus (2017) · cites this paper as Hellgren 2016
Only one trial focused exclusively on physical activity interventions for the prevention of T2DM.
“Only one trial focused exclusively on physical activity interventions for the prevention of T2DM (Hellgren 2016).”
From Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus (2017) · cites this paper as Hellgren 2016
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- Authors
- Hellgren, M. I., Jansson, P.-A., Wedel, H., & Lindblad, U.
- Affiliations
- University of Gothenburg (SE)
- Nordic School of Public Health (SE)
- Corresponding author
- Hellgren, Margareta I.
- Venue
- Scandinavian Journal of Public Health
- Publisher
- SAGE Publications
- Published
- 2016-08-22
- Volume
- 44
- Issue
- 7
- Pages
- 718-725
- ISSN
- 1403-4948 (ISSN-L)
- 1651-1905
- OpenAlex
- W2514799000
- Cited by
- 23
- References
- 21
- Citations by year
- 2025: 3 · 2024: 3 · 2023: 1 · 2022: 5 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 2
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Scandinavian Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- lifestyle intervention, physical activity, insulin resistance, impaired glucose tolerance, impaired fasting glucose, type 2 diabetes prevention, primary care, step counter, group sessions, diastolic blood pressure, HOMA-IR
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