Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: A systematic review for the Community Preventive Services Task Force

Balk, Ethan M.; Earley, Amy; Raman, Gowri; Avendano, Esther A.; Pittas, Anastassios G.; Remington, Patrick L.

doi:10.7326/m15-0452

Cited by 371Physical Activity and HealthDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and Education

Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: A systematic review for the Community Preventive Services Task Force

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Balk, Ethan M., Earley, Amy, Raman, Gowri, Avendano, Esther A., Pittas, Anastassios G., Remington, Patrick L.·2015·Annals of Internal Medicine

DOI 10.7326/m15-0452PMC PMC4692590

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Abstract

BACKGROUND: Trials have shown efficacy of rigorous diet and physical activity promotion programs to reduce diabetes incidence and improve glycemic measures in adults at increased risk for type 2 diabetes. PURPOSE: To evaluate diet and physical activity promotion programs for persons at increased risk for type 2 diabetes, primarily to reduce diabetes risk and decrease body weight and glycemia. DATA SOURCES: MEDLINE, the Cochrane Central Register of Controlled Trials, CAB Abstracts, Global Health, and Ovid HealthSTAR from 1991 through 27 February 2015, with no language restriction. STUDY SELECTION: 8 researchers screened articles for single-group or comparative studies of combined diet and physical activity promotion programs with at least 2 sessions over at least 3 months in participants at increased risk for type 2 diabetes. DATA EXTRACTION: 7 researchers extracted data on study design; participant, intervention, and outcome descriptions; and results and assessed study quality. DATA SYNTHESIS: 53 studies (30 of diet and physical activity promotion programs vs. usual care, 13 of more intensive vs. less intensive programs, and 13 of single programs) evaluated 66 programs. Compared with usual care, diet and physical activity promotion programs reduced type 2 diabetes incidence (risk ratio [RR], 0.59 [95% CI, 0.52 to 0.66]) (16 studies), decreased body weight (net change, -2.2% [CI, -2.9% to -1.4%]) (24 studies) and fasting blood glucose level (net change, -0.12 mmol/L [-2.2 mg/dL] [CI, -0.20 to -0.05 mmol/L {-3.6 to -0.9 mg/dL}]) (17 studies), and improved other cardiometabolic risk factors. Evidence for clinical events was limited. More intensive programs were more effective. LIMITATIONS: Wide variation in diet and physical activity promotion programs limited identification of features most relevant to effectiveness. Evidence on clinical outcomes and in children was sparse. CONCLUSION: Combined diet and physical activity promotion programs are effective at decreasing diabetes incidence and improving cardiometabolic risk factors in persons at increased risk. More intensive programs are more effective. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention Community Preventive Services Task Force.

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Diet and physical activity promotion versus usual care reduced the risk of incident diabetes mellitus (RR 0.59; 95% CI 0.52 to 0.66) while also improving other cardiometabolic risk factors.
“Another systematic review that included 16 studies reported that diet and PA promotion (vs. usual care) reduced the risk of incident DM (RR: 0.59; 95% CI, 0.52 to 0.66) while also improving other cardiometabolic risk factors [96] .”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [96]
The Results, ‘Incident Diabetes,’ report 16 studies comparing diet and physical activity programs with usual care and a summary RR of 0.59; the Abstract, ‘Data Synthesis,’ also reports improvements in cardiometabolic risk factors. However, both passages give the 95% CI as 0.51 to 0.66, not the claimed 0.52 to 0.66. (LLM, conf=0.95)
Experimental — accuracy not yet measured
The Diabetes Prevention Program (DPP) lifestyle intervention reduces the risk of diabetes in individuals with prediabetes, demonstrating 58% risk reduction over 3 years.
“The Diabetes Prevention Program (DPP) lifestyle intervention is the criterion standard for reducing the risk of diabetes in individuals with prediabetes, demonstrating 58% risk reduction over 3 years.5,6”
From An AI-Powered Lifestyle Intervention vs Human Coaching in the Diabetes Prevention Program: A Randomized Clinical Trial (2025) · cites this paper as [6]
The Results (Incident Diabetes; page unavailable) identify the DPP among studies finding reduced diabetes incidence and report significant DPP effects across age groups. The review reports a pooled risk ratio of 0.59 across programs, but does not give a DPP-specific 58% reduction over three years or call the DPP the criterion standard. (LLM, conf=0.85)
Experimental — accuracy not yet measured
More intensive intervention programs are the most effective in decreasing diabetes incidence and improving CVD risk factors.
“More intensive intervention programs are the most effective in decreasing diabetes incidence and improving cardiovascular disease (CVD) risk factors (35).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [35]
Modest, sustained weight loss can delay the progression from prediabetes to type 2 diabetes.
“There is strong and consistent evidence that modest, sustained weight loss can delay the progression from prediabetes to type 2 diabetes (97-99) (see Section 3, “Prevention or Delay of Type 2 Diabetes and Associated Comorbidities”) and is beneficial for the management of type 2 diabetes (see Section 8, “Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes”).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [99]
Modest, sustained weight loss is beneficial for the management of type 2 diabetes.
“There is strong and consistent evidence that modest, sustained weight loss can delay the progression from prediabetes to type 2 diabetes (97-99) (see Section 3, “Prevention or Delay of Type 2 Diabetes and Associated Comorbidities”) and is beneficial for the management of type 2 diabetes (see Section 8, “Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes”).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [99]

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Translating the Diabetes Prevention Program into an Online Social Network: Validation against CDC Standards
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Delaying progression to type 2 diabetes among high-risk Spanish individuals is feasible in real-life primary healthcare settings using intensive lifestyle intervention
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Efficacy of interventions that include diet, aerobic and resistance training components for type 2 diabetes prevention: A systematic review with meta-analysis
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Sex Differences in Diabetes Risk and the Effect of Intensive Lifestyle Modification in the Diabetes Prevention Program
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Pretreatment, Psychological, and Behavioral Predictors of Weight Outcomes Among Lifestyle Intervention Participants in the Diabetes Prevention Program (DPP)
Delahanty, L. M., Peyrot, M. F., Shrader, P. J., Williamson, D. A., Meigs, J. B., & Nathan, D. M. (2012) · Diabetes Care · doi:10.2337/dc12-0733 · Cited by 130 · see citing works
The Healthy Living Partnerships to Prevent Diabetes Study
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Prevention of type 2 diabetes in a primary healthcare setting: Three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance
Sakane, N., Sato, J., Tsushita, K., Tsujii, S., Kotani, K., Tsuzaki, K., Tominaga, M., Kawazu, S., Sato, Y., Usui, T., et al. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-40 · Cited by 126 · see citing works
Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance
Oldroyd, J. C., Unwin, N. C., White, M. J., Mathers, J. C., & Alberti, K. G. M. M. (2005) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2005.09.018 · Cited by 112 · see citing works
Prevention of Diabetes Self-Management Program (PREDIAS): Effects on Weight, Metabolic Risk Factors, and Behavioral Outcomes
Kulzer, B., Hermanns, N., Gorges, D., Schwarz, P. E. H., & Haak, T. (2009) · Diabetes Care · doi:10.2337/dc08-2141 · Cited by 107 · see citing works
Pioglitazone does not enhance the effectiveness of lifestyle modification in preventing conversion of impaired glucose tolerance to diabetes in Asian Indians: results of the Indian Diabetes Prevention Programme-2 (IDPP-2)
Ramachandran, A., Snehalatha, C., Mary, S., Selvam, S., Kumar, C. K. S., Seeli, A. C., & Shetty, A. S. (2009) · Diabetologia · doi:10.1007/s00125-009-1315-x · Cited by 105 · see citing works
Predictors of lifestyle intervention outcome and dropout: the SLIM study
Roumen, C., Feskens, E. J. M., Corpeleijn, E., Mensink, M., Saris, W. H. M., & Blaak, E. E. (2011) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2011.74 · Cited by 88 · see citing works
Outcomes of a 12-Month Technology-Based Intervention to Promote Weight Loss in Adolescents at Risk for Type 2 Diabetes
Patrick, K., Norman, G. J., Davila, E. P., Calfas, K. J., Raab, F., Gottschalk, M., Sallis, J. F., Godbole, S., & Covin, J. R. (2013) · Journal of Diabetes Science and Technology · doi:10.1177/193229681300700322 · Cited by 88 · see citing works
A Coordinated National Model for Diabetes Prevention
Vojta, D., Koehler, T. B., Longjohn, M., Lever, J. A., & Caputo, N. F. (2013) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2012.12.018 · Cited by 87 · see citing works
Diabetes Prevention in the New York City Sikh Asian Indian Community: A Pilot Study
Islam, N. S., Zanowiak, J. M., Wyatt, L. C., Kavathe, R., Singh, H., Kwon, S. C., & Trinh‐Shevrin, C. (2014) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph110505462 · Cited by 82 · see citing works
Improvement of BMI, Body Composition, and Body Fat Distribution With Lifestyle Modification in Japanese Americans With Impaired Glucose Tolerance
Liao, D., Asberry, P. J., Shofer, J. B., Callahan, H. S., Matthys, C. C., Boyko, E. J., Leonetti, D. L., Kahn, S. E., Austin, M. A., Newell, L., et al. (2002) · Diabetes Care · doi:10.2337/diacare.25.9.1504 · Cited by 81 · see citing works
Implementation and effectiveness of the first community lifestyle intervention programme to prevent Type 2 diabetes in Greece. The DE‐PLAN study
Makrilakis, K., Liatis, S., Grammatikou, S., Perrea, D. N., & Katsilambros, N. L. (2010) · Diabetic Medicine · doi:10.1111/j.1464-5491.2010.02918.x · Cited by 78 · see citing works
Randomised controlled trial evaluating the effectiveness of behavioural interventions to modify cardiovascular risk factors in men and women with impaired glucose tolerance: outcomes at 6 months
Oldroyd, J. C., Unwin, N. C., White, M. J., Imrie, K., Mathers, J. C., & Alberti, K. G. M. M. (2001) · Diabetes Research and Clinical Practice · doi:10.1016/s0168-8227(00)00244-8 · Cited by 73 · see citing works
Weight Loss Success in Metabolic Syndrome by Telephone Interventions: Results from the SHINE Study
Weinstock, R. S., Trief, P. M., Cibula, D. A., Morin, P. C., & Delahanty, L. M. (2013) · Journal of General Internal Medicine · doi:10.1007/s11606-013-2529-7 · Cited by 71 · see citing works
A Reduced-Fat Diet and Aerobic Exercise in Japanese Americans With Impaired Glucose Tolerance Decreases Intra-Abdominal Fat and Improves Insulin Sensitivity but not β-Cell Function
Carr, D. B., Utzschneider, K. M., Boyko, E. J., Asberry, P. J., Hull, R. L., Kodama, K., Callahan, H. S., Matthys, C. C., Leonetti, D. L., Schwartz, R. S., et al. (2005) · Diabetes · doi:10.2337/diabetes.54.2.340 · Cited by 69 · see citing works
Effects of lifestyle intervention in persons at risk for type 2 diabetes mellitus - results from a randomised, controlled trial
Nilsen, V., Bakke, P. S., & Gallefoss, F. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-893 · Cited by 65 · see citing works
Changes in insulin secretion and insulin sensitivity in relation to the glycemic outcomes in subjects with impaired glucose tolerance in the Indian Diabetes Prevention Programme-1 (IDPP-1)
Snehalatha, C., Mary, S., Selvam, S., Sathish Kumar, C. K., Shetty, S. B. A., Nanditha, A., & Ramachandran, A. (2009) · Diabetes Care · doi:10.2337/dc09-0676 · Cited by 64 · see citing works
Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study
Kennedy, L. (2007) · Yearbook of Endocrinology · doi:10.1016/s0084-3741(08)70005-2 · Cited by 59 · see citing works
Intensive Lifestyle Intervention in General Practice to Prevent Type 2 Diabetes among 18 to 60-Year-Old South Asians: 1-Year Effects on the Weight Status and Metabolic Profile of Participants in a Randomized Controlled Trial
Admiraal, W. M., Vlaar, E. M., Nierkens, V., Holleman, F., Middelkoop, B. J., Stronks, K., & van Valkengoed, I. G. M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0068605 · Cited by 58 · see citing works
Methodology of a diabetes prevention translational research project utilizing a community-academic partnership for implementation in an underserved Latino community
Merriam, P. A., Tellez, T., Rosal, M. C., Olendzki, B. C., Ma, Y., Pagoto, S., & Ockene, I. S. (2009) · BMC Medical Research Methodology · doi:10.1186/1471-2288-9-20 · Cited by 58 · see citing works
Can the onset of type 2 diabetes be delayed by a group-based lifestyle intervention? A randomised control trial
Moore, S. M., Hardie, E. A., Hackworth, N. J., Critchley, C. R., Kyrios, M., Buzwell, S., & Crafti, N. A. (2010) · Psychology and Health · doi:10.1080/08870440903548749 · Cited by 54 · see citing works
Effect of Intervention in Subjects with High Risk of Diabetes Mellitus in Pakistan
Hydrie, M. Z. I., Basit, A., Shera, A. S., & Hussain, A. (2012) · Journal of Nutrition and Metabolism · doi:10.1155/2012/867604 · Cited by 54 · see citing works
TheLive Well, Be WellStudy: A Community-Based, Translational Lifestyle Program to Lower Diabetes Risk Factors in Ethnic Minority and Lower–Socioeconomic Status Adults
Kanaya, A. M., Santoyo‐Olsson, J., Gregorich, S. E., Grossman, M. D., Moore, T., & Stewart, A. L. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300456 · Cited by 54 · see citing works
Lifestyle Counseling for Type 2 Diabetes Risk Reduction in Dutch Primary Care
Vermunt, P. W. A., Milder, I. E. J., Wielaard, F., de Vries, J. H. M., OERS, H. A. M. V., & Westert, G. P. (2011) · Diabetes Care · doi:10.2337/dc10-2293 · Cited by 52 · see citing works
Implementing a State-Based Cardiovascular Disease and Diabetes Prevention Program
Vanderwood, K. K., Hall, T. O., Harwell, T. S., Butcher, M. K., Helgerson, S. D., & Workgroup, O. B. O. T. M. C. D. A. D. P. P. (2010) · Diabetes Care · doi:10.2337/dc10-0862 · Cited by 52 · see citing works
A lifestyle intervention to reduce Type 2 diabetes risk in Dutch primary care: 2.5‐year results of a randomized controlled trial
Vermunt, P. W. A., Milder, I. E. J., Wielaard, F., de Vries, J. H. M., Baan, C. A., OERS, H. A. M. V., & Westert, G. P. (2012) · Diabetic Medicine · doi:10.1111/j.1464-5491.2012.03648.x · Cited by 51 · see citing works
Impact of Positive Family History and Genetic Risk Variants on the Incidence of Diabetes
Uusitupa, M. I. J., Stančáková, A., Peltonen, M., Eriksson, J. G., Lindström, J., Aunola, S., Ilanne‐Parikka, P., Keinanen-Kiukaanniemi, S. M., Tuomilehto, J., & Laakso, M. (2010) · Diabetes Care · doi:10.2337/dc10-1013 · Cited by 49 · see citing works
Prevention of the metabolic syndrome in IGT subjects in a lifestyle intervention: Results from the SLIM study
den Boer, A. T., Herraets, I. J. T., Stegen, J. H. C. H., Roumen, C., Corpeleijn, E., Schaper, N. C., Feskens, E. J. M., & Blaak, E. E. (2013) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2012.12.005 · Cited by 45 · see citing works
Examining the Psychological Pathways to Behavior Change in a Group-Based Lifestyle Program to Prevent Type 2 Diabetes
Critchley, C. R., Hardie, E. A., & Moore, S. M. (2012) · Diabetes Care · doi:10.2337/dc11-1183 · Cited by 40 · see citing works
Two-year weight-loss maintenance in primary care-based Diabetes Prevention Program lifestyle interventions
Xiao, L., Yank, V, Wilson, S. R., Lavori, P. W., & Ma, J. (2013) · Nutrition & Diabetes · doi:10.1038/nutd.2013.17 · Cited by 39 · see citing works
The effectiveness of "Exercise on Prescription" in stimulating physical activity among women in ethnic minority groups in the Netherlands: protocol for a randomized controlled trial
Hosper, K., Deutekom, M. D. L. F., & Stronks, K. (2008) · BMC Public Health · doi:10.1186/1471-2458-8-406 · Cited by 38 · see citing works
Depression, stress, and weight loss in individuals with metabolic syndrome in SHINE, a DPP translation study
Trief, P. M., Cibula, D. A., Delahanty, L. M., & Weinstock, R. S. (2014) · Obesity · doi:10.1002/oby.20916 · Cited by 37 · see citing works
Benefits on quality of life concomitant to metabolic improvement in intervention program for prevention of diabetes mellitus
Cezaretto, A., Siqueira-Catania, A., de Barros, C. R., Salvador, E. P., & Ferreira, S. R. G. (2011) · Quality of Life Research · doi:10.1007/s11136-011-9919-2 · Cited by 37 · see citing works
Efficacy of Primary Prevention Interventions When Fasting and Postglucose Dysglycemia Coexist
Ramachandran, A., Nanditha, A., Shetty, A. S., & Snehalatha, C. (2010) · Diabetes Care · doi:10.2337/dc09-1150 · Cited by 36 · see citing works
Feasibility and effectiveness of a targeted diabetes prevention program for 18 to 60-year-old South Asian migrants: design and methods of the DH!AAN study
Vlaar, E. M., van Valkengoed, I. G. M., Nierkens, V., Nicolaou, M., Middelkoop, B. J., & Stronks, K. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-371 · Cited by 34 · see citing works
Socioeconomic position and effectiveness of lifestyle intervention in prevention of type 2 diabetes: One-year follow-up of the FIN-D2D project
Rautio, N., Jokelainen, J. J., Oksa, H. H., Saaristo, T., Peltonen, M., NISKANEN, L. K., Puolijoki, H., Vanhala, M. J., Uusitupa, M. I. J., Keinanen-Kiukaanniemi, S. M., et al. (2011) · Scandinavian Journal of Public Health · doi:10.1177/1403494811408482 · Cited by 33 · see citing works
A cost-effective moderate-intensity interdisciplinary weight-management programme for individuals with prediabetes
Gagnon, C., Brown, C., Couture, C., Kamga-Ngandé, C., Hivert, M., Baillargeon, J., Carpentier, A. C., & Langlois, M. (2011) · Diabetes & Metabolism · doi:10.1016/j.diabet.2011.01.003 · Cited by 32 · see citing works
Educational attainment and effectiveness of lifestyle intervention in the Finnish Diabetes Prevention Study
Wikström, K., Peltonen, M., Eriksson, J. G., Aunola, S., Ilanne‐Parikka, P., Keinanen-Kiukaanniemi, S. M., Uusitupa, M. I. J., Tuomilehto, J. O., & Lindström, J. (2009) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2009.06.014 · Cited by 31 · see citing works
A randomized comparative effectiveness trial of using cable television to deliver diabetes prevention programming
Ackermann, R. T., Sandy, L. G., Beauregard, T., Coblitz, M., Norton, K. L., & Vojta, D. D. (2014) · Obesity · doi:10.1002/oby.20762 · Cited by 29 · see citing works
Scaling-up from an implementation trial to state-wide coverage: results from the preliminary Melbourne Diabetes Prevention Study
Janus, E. D., Best, J. D., Davis‐Lameloise, N., Philpot, B., Hernan, A. L., Bennett, C. M., O'Reilly, S. L., Rob, C., Vartiainen, E. A., & Dunbar, J. (2012) · DOAJ (DOAJ: Directory of Open Access Journals) · doi:10.1186/1745-6215-13-152 · Cited by 28 · see citing works
Prevention of type 2 diabetes by lifestyle intervention in primary health care setting in Poland: Diabetes in Europe Prevention using Lifestyle, physical Activity and Nutritional intervention (DE-PLAN) project
Gilis‐Januszewska, A., Szybiński, Z., Kissimova‐Skarbek, K., Piwońska‐Solska, B., Pach, D., Topór‐Mądry, R., Tuomilehto, J. O., Lindström, J., Peltonen, M., Schwarz, P. E. H., et al. (2011) · The British Journal of Diabetes · doi:10.1177/1474651411412429 · Cited by 27 · see citing works
Effectiveness of Prediabetes Nutrition Shared Medical Appointments
Cole, R. E., Boyer, K. M., Spanbauer, S. M., Sprague, D. C., & Bingham, M. O. (2013) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721713484812 · Cited by 26 · see citing works
Feasibility, acceptability and outcomes at a 12-month follow-up of a novel community-based intervention to prevent type 2 diabetes in adults at high risk: mixed methods pilot study
Penn, L., Ryan, V., & White, M. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003585 · Cited by 25 · see citing works
Predictors of Success of a Lifestyle Intervention in Relation to Weight Loss and Improvement in Glucose Tolerance Among Individuals at High Risk for Type 2 Diabetes
Rautio, N., Jokelainen, J. J., Saaristo, T., Oksa, H. H., Keinanen-Kiukaanniemi, S. M., & the FIN-D2D Writing Group (2012) · Journal of Primary Care & Community Health · doi:10.1177/2150131912444130 · Cited by 22 · see citing works
Family history of diabetes and effectiveness of lifestyle counselling on the cardio‐metabolic risk profile in individuals at high risk of Type 2 diabetes: 1‐year follow‐up of the FIN‐D2D project
Rautio, N., Jokelainen, J. J., Oksa, H. H., et al. (2011) · Diabetic Medicine · doi:10.1111/j.1464-5491.2011.03388.x · Cited by 19 · see citing works
Effect of baseline HbA1c level on the development of diabetes by lifestyle intervention in primary healthcare settings: insights from subanalysis of the Japan Diabetes Prevention Program
Sakane, N., Sato, J., Tsushita, K., Tsujii, S., Kotani, K., Tominaga, M., Kawazu, S., Sato, Y., Usui, T., Kamae, I., et al. (2014) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2013-000003 · Cited by 18 · see citing works
The influence of depression and anxiety on outcomes after an intervention for prediabetes
Kyrios, M., Moore, S. M., Hackworth, N. J., Buzwell, S., Crafti, N. A., Critchley, C. R., & Hardie, E. (2009) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2009.tb02476.x · Cited by 17 · see citing works
Participation, socioeconomic status and group or individual counselling intervention in individuals at high risk for type 2 diabetes: One-year follow-up study of the FIN-D2D-project
Rautio, N., Jokelainen, J. J., Oksa, H. H., et al. (2012) · Primary care diabetes · doi:10.1016/j.pcd.2012.07.002 · Cited by 17 · see citing works
Baseline Obesity Status Modifies Effectiveness of Adapted Diabetes Prevention Program Lifestyle Interventions for Weight Management in Primary Care
Azar, K. M. J., Xiao, L., & Ma, J. (2013) · BioMed Research International · doi:10.1155/2013/191209 · Cited by 17 · see citing works
Impact of health professionals’ contact frequency on response to a lifestyle intervention with individuals at high risk for diabetes
B̀ouchard, D. R., Baillargeon, J., Gagnon, C., Brown, C., & Langlois, M. (2012) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2011.12.019 · Cited by 15 · see citing works
Prevention of Diabetes in Family Medicine
Alibašić, E., Ramić, E., & Alić, A. (2013) · Materia Socio Medica · doi:10.5455/msm.2013.25.80-82 · Cited by 15 · see citing works
The effect of a non-intensive community-based lifestyle intervention on the prevalence of Metabolic Syndrome. The DEPLAN study in Greece
Makrilakis, K., Grammatikou, S., Liatis, S., Kontogianni, M. D., Perrea, D. N., Dimosthenopoulos, C., Poulia, K., & Katsilambros, N. L. (2012) · HORMONES · doi:10.14310/horm.2002.1360 · Cited by 12 · see citing works
Sustained gains from a diabetes prevention program and the role of telephone support
Dunbar, J., Davis‐Lameloise, N., Philpot, B., Reddy, P., Bunker, S. J., Heistaro, S., Laatikainen, T. K., & Janus, E. D. (2010) · International Journal of Diabetes Mellitus · doi:10.1016/j.ijdm.2010.05.002 · Cited by 7 · see citing works
An Outpatient-Based Clinical Program For Diabetes Prevention: an Update
Swanson, C. M., Bersoux, S., Larson, M. H., Aponte-Furlow, R. T., Flatten, S. S., Olsen, C. L., LaRosa, C. S., Verona, P. M., Jameson, K. A., & Cook, C. B. (2011) · Endocrine Practice · doi:10.4158/ep11226.or · Cited by 6 · see citing works
Do depressive symptoms have an impact on the effectiveness of lifestyle counseling in prevention of type 2 diabetes? One-year follow-up of FIN-D2D
Rautio, N., Jokelainen, J. J., Oksa, H. H., Saaristo, T., Moilanen, L., Vanhala, M. J., Peltonen, M., Korpi-Hyövälti, E., Tuomilehto, J. O., Uusitupa, M. I. J., et al. (2013) · Primary care diabetes · doi:10.1016/j.pcd.2013.10.005 · Cited by 4 · see citing works
DETECTING AND MANAGING METABOLIC SYNDROME :AF EASIBILITY STUDY IN A GENERAL MEDICINE CLINIC
Tahsin, B., Sanghani, R., Pikelny, I., et al. (2008) · Cited by 2 · see citing works

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Physical activity/exercise and diabetes: A position statement of the American Diabetes Association
Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., Horton, E. S., Castorino, K., & Tate, D. F. (2016) · Diabetes Care · doi:10.2337/dc16-1728 · Cited by 2,991 · see citing works
Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report
Evert, A. B., Dennison, M., Gardner, C. D., Garvey, W. T., Lau, K. H. K., MacLeod, J., Mitri, J., Pereira, R. F., Rawlings, K., Robinson, S., et al. (2019) · Diabetes Care · doi:10.2337/dci19-0014 · Cited by 1,496 · see citing works
“tion programs are the most effective in decreasing diabetes incidence and improving cardiovascular disease (CVD) risk factors (35).”
5. Lifestyle Management:Standards of Medical Care in Diabetes—2019
American Diabetes Association (2019) · Diabetes Care · doi:10.2337/dc19-s005 · Cited by 700 · see citing works
Metabolomic profiles predict individual multidisease outcomes
Buergel, T., Steinfeldt, J., Ruyoga, G., Pietzner, M., Bizzarri, D., Vojinovic, D., Upmeier zu Belzen, J., Loock, L., Kittner, P., Christmann, L., et al. (2022) · Nature Medicine · doi:10.1038/s41591-022-01980-3 · Cited by 406 · see citing works
A National Effort to Prevent Type 2 Diabetes: Participant-Level Evaluation of CDC's National Diabetes Prevention Program
Ely, E. K., Gruss, S. M., Luman, E. T., Gregg, E. W., Ali, M. K., Nhim, K., Rolka, D. B., & Albright, A. L. (2017) · Diabetes Care · doi:10.2337/dc16-2099 · Cited by 386 · see citing works
5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc23-s005 · Cited by 362 · see citing works
5. Facilitating Behavior Change and Well-being to Improve Health Outcomes:Standards of Medical Care in Diabetes—2022
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s005 · Cited by 445 · see citing works
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
Hemmingsen, B., Gimenez-Perez, G., Mauricio, D., Roqué i Figuls, M., Metzendorf, M.-I., & Richter, B. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003054.pub4 · Cited by 316 · see citing works
5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Eichorst, B., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s005 · Cited by 305 · see citing works
Position of the Academy of Nutrition and Dietetics: the role of medical nutrition therapy and registered dietitian nutritionists in the prevention and treatment of prediabetes and type 2 diabetes
Briggs Early, K., & Stanley, K. (2018) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2017.11.021 · Cited by 203 · see citing works
The effectiveness and cost of lifestyle interventions including nutrition education for diabetes prevention: a systematic review and meta-analysis
Sun, Y., You, W., Almeida, F., Estabrooks, P., & Davy, B. (2017) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2016.11.016 · Cited by 186 · see citing works
Interventions for Reversing Prediabetes: A Systematic Review and Meta-Analysis
Galaviz, K. I., Weber, M. B., Suvada, K., Gujral, U. P., Wei, J., Merchant, R., Dharanendra, S., Haw, J. S., Narayan, K. M. V., & Ali, M. K. (2022) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.10.020 · Cited by 149 · see citing works
Over-the-Counter Supplement Interventions to Prevent Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer-Type Dementia: A Systematic Review
Butler, M., Nelson, V. A., Davila, H., Ratner, E., Fink, H. A., Hemmy, L. S., McCarten, J. R., Barclay, T. R., Brasure, M., & Kane, R. L. (2018) · Annals of Internal Medicine · doi:10.7326/m17-1530 · Cited by 144 · see citing works
Factors affecting weight loss variability in obesity
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Authors: Balk, E. M., Earley, A., Raman, G., Avendano, E. A., Pittas, A. G., & Remington, P. L.
Affiliations: Tufts Medical Center (US)
From Brown University School of Public Health, Providence, Rhode Island; Tufts Medical Center and Mapi Group, Boston, Massachusetts; and University of Wisconsin, Madison, Wisconsin.
ORCID: Balk, Ethan M.
Earley, Amy
Raman, Gowri
Pittas, Anastassios G.
Remington, Patrick L.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2015-09-15
Volume: 163
Issue: 6
Pages: 437-451
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/m15-0452
PMC: PMC4692590
OpenAlex: W1938758241
Cited by: 371
References: 123
Citations by year: 2026: 14 · 2025: 20 · 2024: 39 · 2023: 18 · 2022: 33 · 2021: 32 · 2020: 38 · 2019: 32 · 2018: 52 · 2017: 38 · 2016: 37 · 2015: 15
FWCI: 5.78
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (CC999999)
National Institute of Diabetes and Digestive and Kidney Diseases (U01DK098245)
Topics: Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords: type 2 diabetes prevention, physical activity promotion programs, diabetes risk, weight loss, fasting blood glucose, cardiometabolic risk factors, diabetes incidence, program intensity, community-based intervention
MeSH terms: Blood Glucose, Blood Pressure, Diabetes Mellitus, Type 2, Diet, Reducing, Health Promotion, Humans, Lipids, Risk Factors, Weight Loss, Exercise

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Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: A systematic review for the Community Preventive Services Task Force

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