Lifestyle Counseling Reduces Risk of Developing Type 2 Diabetes

A lifestyle counseling program was effective and feasible in individuals with an elevated risk for type 2 diabetes and was associated with favorable outcomes for several clinical risk factors, including body mass index (BMI), waist circumference, and diastolic blood pressure

Pilvikki Absetz, PhD, from the National Public Health Institute in Helsinki, Finland, writes that,  "’Real-world’ implementation of lifestyle interventions is a challenge." "The Good Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial was designed for the primary health care setting, with lifestyle and risk reduction objectives derived from the major diabetes prevention efficacy trials. We report on the program’s effectiveness as well as findings related to the program’s reach, adoption, and implementation."

At healthcare centers in Finland, 352 middle-aged participants at increased risk for type 2 diabetes were recruited and were given an intervention consisting of 6 group counseling sessions led by trained public health nurses. At baseline, the study nurses measured clinical risk factors. Lifestyle outcomes were analyzed from self-reports at baseline and at 12 months and were compared with outcomes achieved in relevant efficacy trials. Risk reduction was determined from within-subject changes.

Mean baseline BMI was more than 32 kg/m2, and 25% of participants initially had impaired glucose tolerance levels. At least 4 of 5 key lifestyle outcomes were achieved by 20% of participants at 12 months. Although these results were similar to those observed in reference trials, physical activity and weight loss goals (–5%) were achieved significantly less frequently (65% vs 86% and 12% vs 43%, respectively).

Reductions were noted in several clinical risk factors, particularly in men more so than in women. These included glucose tolerance levels at follow-up, BMI and waist circumference, and diastolic blood pressure.

"This trial demonstrates that lifestyle counseling can be effective and is feasible in real-world settings for individuals with elevated risk of type 2 diabetes," the study authors write. "To increase program impact, program exposure and treatment intensity need to be increased."

"Explicit lifestyle change objectives provide practical targets for counseling, and their attainment also predicts risk factor change, but ways to further promote physical activity and weight loss need to be considered," the study authors conclude.

Practice Pearls

• Implementation of strategies for diabetes prevention in the community is associated with adoption of lifestyle changes that address the risk for diabetes at 1 year.
• Patients at risk for diabetes who achieve 4 or more lifestyle objectives show a lower risk of developing diabetes at 1 year.

Diabetes Care. 2007;30:2465-2470.

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