Lifestyle intervention for impaired glucose tolerance wards off vascular mortality

By Eleanor McDermid, Senior medwireNews Reporter

Implementing lifestyle changes in patients with impaired glucose tolerance has lasting cardiovascular benefits, show findings published in The Lancet Diabetes & Endocrinology.

During 23 years of follow-up of participants of the Da Qing Diabetes Prevention Study, the risk of cardiovascular mortality, all-cause mortality and new-onset diabetes was significantly reduced among those who underwent a 6-year lifestyle intervention at the start of the trial, relative to those who received usual care.

In an accompanying commentary, Nicholas Wareham (University of Cambridge, UK) says that the results “are a real breakthrough, showing that lifestyle intervention can reduce the risk of long-term cardiovascular consequences of diabetes.”

At baseline, the 576 study participants were randomly assigned according to the clinic they attended to receive usual care or a lifestyle intervention, which lasted 6 years and involved diet, exercise or both. During follow-up, the cumulative incidence of cardiovascular mortality was 11.9% among participants in the intervention groups, compared with 19.6% among those in the control group, giving a significant 41% relative difference.

The corresponding all-cause mortality rates were 28.1% versus 38.4%, for a significant relative difference of 29%, and diabetes incidence was 72.6% versus 89.9%, giving a significant 45% relative difference.

Of note, the effect of the lifestyle intervention on mortality and cardiovascular mortality appeared to be mediated by the reduced conversion to diabetes. Longer time to diabetes onset was associated with a reduced risk of mortality and cardiovascular mortality, and the effect of the intervention on these outcomes became nonsignificant after accounting for time to diabetes onset.

The lifestyle intervention reduced diabetes onset to a similar degree in men and women, but the effect on mortality and cardiovascular was only significant in women. This difference persisted even after accounting for smoking, which was more common in men. Lead study author Guangwei Li (China-Japan Friendship Hospital, Beijing) and team suggest that women may have been more adherent than men to the intervention measures.

They conclude: “Our findings imply that implementation of lifestyle intervention for people with impaired glucose tolerance – especially women – who are at high risk for diabetes in China, or elsewhere, would reduce the incidence of diabetes and associated health-care expenditure, eventually resulting in a lower number of diabetes-related deaths.”

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