CoChat
Sign Up
Cited by 542Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and EducationDiabetes Treatment and Management

Diabetes Prevention in the Real World: Effectiveness of Pragmatic Lifestyle Interventions for the Prevention of Type 2 Diabetes and of the Impact of Adherence to Guideline Recommendations

Open access
Dunkley, Alison J., Bodicoat, Danielle H., Greaves, Colin J., Russell, Claire, Yates, Thomas, Davies, Melanie J., Khunti, Kamlesh·2014·Diabetes Care
DOI 10.2337/dc13-2195
Open this paper in CoChat — free accountOpen PDF

Abstract

OBJECTIVE: To summarize the evidence on effectiveness of translational diabetes prevention programs, based on promoting lifestyle change to prevent type 2 diabetes in real-world settings and to examine whether adherence to international guideline recommendations is associated with effectiveness. RESEARCH DESIGN AND METHODS: Bibliographic databases were searched up to July 2012. Included studies had a follow-up of ≥12 months and outcomes comparing change in body composition, glycemic control, or progression to diabetes. Lifestyle interventions aimed to translate evidence from previous efficacy trials of diabetes prevention into real-world intervention programs. Data were combined using random-effects meta-analysis and meta-regression considering the relationship between intervention effectiveness and adherence to guidelines. RESULTS: Twenty-five studies met the inclusion criteria. The primary meta-analysis included 22 studies (24 study groups) with outcome data for weight loss at 12 months. The pooled result of the direct pairwise meta-analysis shows that lifestyle interventions resulted in a mean weight loss of 2.32 kg (95% CI −2.92 to −1.72; I2 = 93.3%). Adherence to guidelines was significantly associated with a greater weight loss (an increase of 0.4 kg per point increase on a 12-point guideline-adherence scale). CONCLUSIONS: Evidence suggests that pragmatic diabetes prevention programs are effective. Effectiveness varies substantially between programs but can be improved by maximizing guideline adherence. However, more research is needed to establish optimal strategies for maximizing both cost-effectiveness and longer-term maintenance of weight loss and diabetes prevention effects.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.2337/dc13-2195

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The authors' weight-loss findings are consistent with other meta-analyses showing a pre/post weight loss of 2.3-3.8 kg and a between-group weight loss difference of 1.6-2.7 kg.

    “Regarding weight loss, our findings are consistent with those from other meta-analyses showing a pre/post weight loss of 2.3–3.8 kg (9,10) and a between-group weight loss difference of 1.6–2.7 kg (7,9,10,14).”

    From Global diabetes prevention interventions: A systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose (2018) · cites this paper as [9]

    The Strengths and Limitations section reports 2.3 kg of weight loss in an RCT-only sensitivity analysis, matching the lower end of the cited pre/post range. The Meta-analysis section reports 2.12 kg for the primary pooled result, while Data Synthesis and Analysis says only intervention arms were included; this paper therefore does not establish the claimed 1.6–2.7 kg between-group difference. Page numbers are unavailable in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Existing meta-analyses show that lifestyle modification strategies to prevent type 2 diabetes delivered under real-world conditions are effective for promoting weight loss.

    “Existing meta-analyses show that LSM strategies to prevent type 2 diabetes that are delivered under real-world conditions are effective for promoting weight loss (7–11)”

    From Global diabetes prevention interventions: A systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose (2018) · cites this paper as [9]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 48

  1. Hamman RF, Wing RR, Edelstein SL, et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care 2006;29: 2102-2107
  2. Schwarz PE, Greaves CJ, Lindstrom J, Yates T, Davies MJ. Nonpharmacological interventions for the prevention of type 2 diabetes mellitus. Nat Rev Endocrinol 2012;8:363-373
  3. Johnson M, Jones R, Freeman C, et al. Can diabetes prevention programmes be translated effectively into real-world settings and still de- liver improved outcomes? A synthesis of evi- dence. Diabet Med 2013;30:3-15
  4. Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997;20: 537-544
  5. Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V; Indian Diabetes Prevention Programme (IDPP). The Indian Dia- betes Prevention Programme shows that life- style modification and metformin prevent type 2 diabetes in Asian Indian subjects with im- paired glucose tolerance (IDPP-1). Diabetologia 2006;49:289-297
  6. Ali MK, Echouffo-Tcheugui J, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? Health Aff (Millwood) 2012;31:67-75
  7. Taylor J, Cottrell C, Chatterton H, et al. Iden- tifying risk and preventing progression to Type 2 diabetes in vulnerable and disadvantaged adults: a pragmatic review. Diabet Med 2013;30:16-25
  8. Gillett M, Royle P, Snaith A, et al. Non- pharmacological interventions to reduce the risk of diabetes in people with impaired glu- cose regulation: a systematic review and eco- nomic evaluation. Health Technol Assess 2012; 16:1-236
  9. Baker MK, Simpson K, Lloyd B, Bauman AE, Singh MAF. Behavioral strategies in diabetes prevention programs: a systematic review of randomized controlled trials (Abstract). Diabe- tes Res Clin Pract 2011;91:1-12
  10. Angermayr L, Melchart D, Linde K. Multifac- torial lifestyle interventions in the primary and secondary prevention of cardiovascular disease and type 2 diabetes mellitusda systematic re- view of randomized controlled trials. Ann Behav Med 2010;40:49-64
  11. Yamaoka K, Tango T. Efficacy of lifestyle ed- ucation to prevent type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2005;28:2780-2786
  12. Greaves CJ, Sheppard KE, Abraham C, et al.; IMAGE Study Group. Systematic review of re- views of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health 2011;11:119
  13. Burnett RW, D'Orazio P, Fogh-Andersen N, et al. IFCC recommendation on reporting results for blood glucose. Clin Chim Acta 2001;307:205- 209
  14. Gilis-Januszewska A, Szybinski Z, Kissimova- Skarbek K, et al. Prevention of type 2 diabetes by lifestyle intervention in primary health care setting in Poland: Diabetes in Europe Preven- tion Using Lifestyle, Physical Activity and Nutri- tional Intervention (DE-PLAN) project. Br J Diabetes Vasc Dis 2011;11:198-203
  15. Makrilakis K, Liatis S, Grammatikou S, Perrea D, Katsilambros N. Implementation and effectiveness of the first community lifestyle in- tervention programme to prevent Type 2 diabe- tes in Greece. The DE-PLAN study. Diabet Med 2010;27:459-465
  16. Kramer MK, Kriska AM, Venditti EM, et al. Translating the diabetes prevention program: a comprehensive model for prevention training and program delivery. Am J Prev Med 2009 12; 37:505-511
  17. Kulzer B, Hermanns N, Gorges D, Schwarz P, Haak T. Prevention of Diabetes Self-Management Program (PREDIAS): effects on weight, metabolic risk factors, and behavioral outcomes. Diabetes Care 2009;32:1143-1146
  18. Laatikainen T, Dunbar JA, Chapman A, et al. Prevention of type 2 diabetes by lifestyle inter- vention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project. BMC Public Health 2007;7: 249
  19. Absetz P, Valve R, Oldenburg B, et al. Type 2 diabetes prevention in the "real world": one- year results of the GOAL Implementation Trial. Diabetes Care 2007;30:2465-2470
  20. Ackermann RT, Finch EA, Brizendine E, Zhou H, Marrero DG. Translating the diabetes preven- tion program into the community: the DEPLOY pilot study. Am J Prev Med 2008;35:357-363
  21. Almeida FA, Shetterly S, Smith-Ray RL, Estabrooks PA. Reach and effectiveness of a weight loss intervention in patients with predi- abetes in Colorado. Prev Chronic Dis 2010;7: A103
  22. Boltri JM, Davis-Smith YM, Seale JP, Shellenberger S, Okosun IS, Cornelius ME. Diabetes prevention in a faith-based setting: re- sults of translational research. J Public Health Manag Pract 2008;14:29-32
  23. Costa B, Barrio F, Cabre JJ, et al.; DE- PLAN-CAT Research Group. Delaying pro- gression to type 2 diabetes among high-risk Spanish individuals is feasible in real-life pri- mary healthcare settings using intensive lifestyle intervention. Diabetologia 2012 May 2012;55: 1319-1328
  24. Davis-Smith YM, Boltri JM, Seale JP, Shellenberger S, Blalock T, Tobin B. Imple- menting a diabetes prevention program in a rural African-American church. J Natl Med Assoc 2007; 99:440-446
  25. Faridi Z, Shuval K, Njike VY, et al.; PREDICT Project Working Group. Partners Reducing Ef- fects of Diabetes (PREDICT): a diabetes preven- tion physical activity and dietary intervention through African-American churches. Health Educ Res 2010;25:306-315
  26. Mensink M, Blaak EE, Corpeleijn E, Saris WH, de Bruin TW, Feskens EJ. Lifestyle interven- tion according to general recommendations im- proves glucose tolerance. Obes Res 2003;11: 1588-1596
  27. Nilsen V, Bakke PS, Gallefoss F. Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus -results from a randomised, controlled trial. BMC Public Health 2011;11:893
  28. Payne WR, Walsh KJ, Harvey JT, et al. Effect of a low-resource-intensive lifestyle modifica- tion program incorporating gymnasium-based and home-based resistance training on type 2 diabetes risk in Australian adults. Diabetes Care 2008;31:2244-2250
  29. Penn L, White M, Oldroyd J, Walker M, Alberti KG, Mathers JC. Prevention of type 2 di- abetes in adults with impaired glucose toler- ance: the European Diabetes Prevention RCT in Newcastle upon Tyne, UK. BMC Public Health 2009;9:342
  30. Ruggiero L, Oros S, Choi YK. Community- based translation of the diabetes prevention program's lifestyle intervention in an under- served Latino population. Diabetes Educ 2011; 37:564-572
  31. Saaristo T, Moilanen L, Korpi-Hyövälti E, et al. Lifestyle intervention for prevention of type 2 diabetes in primary health care: one- year follow-up of the Finnish National Diabetes Prevention Program (FIN-D2D). Diabetes Care 2010;33:2146-2151
  32. Sakane N, Sato J, Tsushita K, et al.; Japan Diabetes Prevention Program (JDPP) Research Group. Prevention of type 2 diabetes in a pri- mary healthcare setting: three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance. BMC Public Health 2011;11:40
  33. Vermunt PWA, Milder IEJ, Wielaard F, et al. A lifestyle intervention to reduce Type 2 diabe- tes risk in Dutch primary care: 2.5-year results of a randomized controlled trial. Diabet Med 2012;29:e223-e231
  34. Yates T, Davies M, Gorely T, Bull F, Khunti K. Effectiveness of a pragmatic education program designed to promote walking activity in individ- uals with impaired glucose tolerance: a random- ized controlled trial. Diabetes Care 2009;32: 1404-1410
  35. Absetz P, Oldenburg B, Hankonen N, et al. Type 2 diabetes prevention in the real world: three-year results of the GOAL lifestyle implemen- tation trial. Diabetes Care 2009;32:1418-1420
  36. Laatikainen T, Philpot B, Hankonen N, et al. Predicting changes in lifestyle and clinical out- comes in preventing diabetes: the Greater Green Triangle Diabetes Prevention Project. Prev Med 2012;54:157-161
  37. Mensink M, Feskens EJM, Saris WHM, De Bruin TWA, Blaak EE. Study on Lifestyle Inter- vention and Impaired Glucose Tolerance Maas- tricht (SLIM): preliminary results after one year. Int J Obes Relat Metab Disord 2003;27:377-384
  38. Roumen C, Corpeleijn E, Feskens EJM, Mensink M, Saris WHM, Blaak EE. Impact of 3-year lifestyle intervention on postprandial glucose metabolism: the SLIM study. Diabet Med 2008;25:597-605
  39. Roumen C, Feskens EJM, Corpeleijn E, Mensink M, Saris WHM, Blaak EE. Predictors of lifestyle intervention outcome and dropout: the SLIM study. Eur J Clin Nutr 2011;65:1141-1147
  40. Rautio N, Jokelainen J, Oksa H, et al.; FIN- D2D Study Group. Socioeconomic position and effectiveness of lifestyle intervention in preven- tion of type 2 diabetes: one-year follow-up of the FIN-D2D project. Scand J Public Health 2011; 39:561-570
  41. Rautio N, Jokelainen J, Oksa H, et al. Family history of diabetes and effectiveness of lifestyle counselling on the cardio-metabolic risk pro- file in individuals at high risk of Type 2 diabetes: 1-year follow-up of the FIN-D2D project. Diabet Med 2012;29:207-211
  42. Vermunt PWA, Milder IEJ, Wielaard F, de Vries JHM, van Oers HAM, Westert GP. Lifestyle counseling for type 2 diabetes risk reduction in Dutch primary care: results of the APHRODITE study after 0.5 and 1.5 years. Diabetes Care 2011;34:1919-1925
  43. Yates T, Davies MJ, Sehmi S, Gorely T, Khunti K. The Pre-diabetes Risk Education and Physical Activity Recommendation and Encouragement (PREPARE) programme study: are improvements in glucose regulation sus- tained at 2 years? Diabet Med 2011;28:1268- 1271
  44. Herman WH, Smith PJ, Thompson TJ, Engelgau MM, Aubert RE. A new and simple questionnaire to identify people at increased risk for undiagnosed diabetes. Diabetes Care 1995;18:382-387
  45. Morris DH, Khunti K, Achana F, et al. Pro- gression rates from HbA1c 6.0-6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis. Diabetologia 2013;56:1489- 1493
  46. Dansinger ML, Tatsioni A, Wong JB, Chung M, Balk EM. Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med 2007;147:41-50
  47. Carter P, Gray LJ, Troughton J, Khunti K, Davies MJ. Fruit and vegetable intake and inci- dence of type 2 diabetes mellitus: systematic review and meta-analysis. BMJ 2010;341 (c4429):c4229
  48. Reed VA, Schifferdecker KE, Rezaee ME, O'Connor S, Larson RJ. The effect of computers for weight loss: a systematic review and meta- analysis of randomized trials. J Gen Intern Med 2012;27:99-108

Cited by

Sorted by citations

Authors
Dunkley, A. J., Bodicoat, D. H., Greaves, C. J., Russell, C., Yates, T., Davies, M. J., & Khunti, K.
Affiliations
  • University of Leicester (GB)
  • University of Exeter (GB)
Corresponding author
Dunkley, Alison J.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2014-03-08
Volume
37
Issue
4
Pages
922-933
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc13-2195
OpenAlex
W1968893175
Cited by
542
References
14
Citations by year
2026: 9 · 2025: 18 · 2024: 26 · 2023: 38 · 2022: 34 · 2021: 61 · 2020: 48 · 2019: 52 · 2018: 70 · 2017: 58 · 2016: 60 · 2015: 49 · 2014: 19
FWCI
49.84
Type
journal article
Language
en
Update notices
correction (2014-06-01)
Open access
Licence
Locations
  • Diabetes Care (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
  • Open Research Exeter (University of Exeter) (submittedVersion, cc-by-nc-nd)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by-nc-nd)
Funders
  • University of Pennsylvania
  • National Institute for Health and Care Research (CDF-2012-05-259)
  • University of Leicester
  • Novartis Pharma
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
type 2 diabetes prevention, lifestyle intervention, weight loss, guideline adherence, glycemic control, body composition, cost-effectiveness, weight loss maintenance
MeSH terms
Behavior Therapy, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Health Promotion, Humans, Life Style, Guideline Adherence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review