The Effect Of Lifestyle Intervention On Preventing Or Delaying Onset Of Diabetes In Relation Of Cardiovascular Disease In Chinese Subjects With Impaired Glucose Tolerance

OBJECTIVES(1) To compare the long-term effect of diet and exercise on prevention of diabetes in people with impaired glucose tolerance in DaQing diabetes study,in order to find which one will be the best option.(2)To Investigate the effect of delaying onset of diabetes on all cause and CVD mortality,incidence of CVD event and stroke in this prediabetes population.METHODS 576 participants were followed-up for 20 years to assess the long-term effect of diet or exercise intervention.The causes of death,the status of survivors were investigated.Questionnaires were given to all the participants or their proxy.Height,weight,blood pressure were measured,ECG,oral glucose tolerance test and blood biochemical analysis were performed in the survivors.Long-term effect of lifestyle intervention were examed in relation to incidence of diabetes,stroke,first CVD event and mortality.RESULTS Compared with control participants,those in the diet intervention group and exercise intervention group had 46%(hazard rate ratio[HRR]0.54;95%CI 0.34-0.88) and 51%lower incidence of diabetes(0.49;0.27-0.87)respectively during the active intervention period,their HRR were 0.59(95%CI 0.39-0.89,p=0.0152) and 0.53(0.33-0.85 p=0.0117) over the 20 year period,after controlling for age,BMI and clustering by clinic.There was no significant difference between the diet and exercise group in the incidence of diabetes.In the subgroup with BMI＜25kg/m~2,those in exercise intervention groups had a 66%lower incidence of diabetes(0.34;0.16-0.73) compared with control during the active intervention period and a 62%lower incidence(0.38;0.20-0.71) over the 20 year period.But the effect of the diet intervention was not obvious.In the subgroup with BMI≥25kg/m~2,both the diet intervention and exercise intervention were effective on prevention diabetes during the active intervention period and the 20 year follow-up period.There were no differences between diet and exercise intervention in the two subgroups.After adjustment of age,sex,BMI,blood pressure,smoking at baseline,the risk of all-cause mortality was 38%lower for 5-year increase of delaying diabetes onset,and the risk of stroke,CVD event and mortality were 18%,18%,26%lower respectively for the same increase in the time of delaying of diabetes onset.All these results were statistically significant.CONCLUSIONS(1) Both the diet and exercise interventions over 6 years can prevent or delay diabetes for up to 14 years after the active intervention.But the exercise intervention seems better on diabetes prevention in the non-overweight people.(2) There were significant decrease in the risk of all-cause and CVD mortality, incidence of stroke and first CVD event when diabetes onset was delayed for 5 years.