Weight Loss Should be the Primary Intervention for Risk of Diabetes

In a randomized trial with 1079 participants, for over 3 years it was found that for every 2 pounds of weight loss there was a 16% reduction in risk. Diabetes Prevention Program (DPP) participants randomized to the intensive lifestyle intervention (ILS) had significantly reduced risk of diabetes compared with placebo participants. We explored the contribution of changes in weight, diet, and physical activity on the risk of developing diabetes among ILS participants.

A total of 1,079 participants were aged 25–84 years (mean 50.6 years, BMI 33.9 kg/m2). Weight loss was the dominant predictor of reduced diabetes incidence (hazard ratio per 5-kg weight loss 0.42 [95% CI 0.35–0.51]; P < 0.0001). For every kilogram of weight loss, there was a 16% reduction in risk, adjusted for changes in diet and activity. Lower percent of calories from fat and increased physical activity predicted weight loss. Increased physical activity was important to help sustain weight loss. Among 495 participants not meeting the weight loss goal at year 1, those who achieved the physical activity goal had 44% lower diabetes incidence.

With the increasing prevalence of overweight and adoption of a Western lifestyle, many populations are at risk of developing diabetes and may be reasonable candidates for a prevention intervention like that of the DPP. Weight loss, largely determined by changes in diet and exercise, is the primary factor resulting in reduced diabetes incidence among those in the ILS group. An increase in physical activity helps sustain weight loss and independently reduces diabetes risk among those who do not lose weight. Interventions to reduce the incidence of diabetes should aim at weight loss as the primary determinant of success.
Diabetes Care 29: 2102-2107.

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