Improvement in diet habits, independent of physical activity helps to reduce incident diabetes among prediabetic Asian Indian men

doi:10.1016/j.diabres.2014.09.043

Diabetes Research and Clinical Practice

Volume 106, Issue 3, December 2014, Pages 491-495

https://doi.org/10.1016/j.diabres.2014.09.043 Get rights and content

Abstract

Aims

To assess the beneficial effects of the components of lifestyle intervention in reducing incidence of diabetes in Asian Indian men with impaired glucose tolerance (IGT) in India.

Methods

This analysis was based on a 2 year prospective, randomized controlled primary prevention trial in a cohort of Asian Indian men with IGT (n = 537) (Clinical Trial No: NCT00819455). Intervention and control groups were given standard care advice at baseline. Additionally, the intervention group received frequent, mobile phone based text message reminders on healthy lifestyle principles. Dietary intake and physical activity habits were recorded by validated questionnaires. The lifestyle goals were: reductions in consumption of carbohydrates, oil, portion size and body mass index of at least 1 unit (1 kg/m²) from baseline and maintenance of good physical activity. The association between diabetes and lifestyle goals achieved was assessed using multiple logistic regression analyses. Changes in insulin sensitivity (Matsuda's insulin sensitivity index) and oral disposition index during the follow-up were assessed.

Results

At the end of the study, 123 (23.8%) participants developed diabetes. The mean lifestyle score was higher in the intervention group compared with control (2.59 ± 1.13 vs. 2.28 ± 1.17; P = 0.002). Among the 5 lifestyle variables, significant improvements in the 3 dietary goal were seen with intervention. Concomitant improvement in insulin sensitivity and oral disposition index was noted. Higher lifestyle score was associated with lower risk of developing diabetes (odds ratio: 0.54 [95% CI: 0.44–0.70]; P < 0.0001).

Conclusions

Beneficial effects of intervention were associated with increased compliance to lifestyle goals. The plausible mechanism is through improvement in insulin sensitivity and beta cell preservation.

Introduction

The rising prevalence of common behavioural risk factors, namely poor diet, lack of physical activity, tobacco use and excessive alcohol consumption are associated with increased prevalence of diabetes, cardiovascular diseases, cancer and chronic pulmonary diseases. These diseases account for nearly 80% of deaths from non-communicable diseases (NCD), especially in developing countries [1]. Several randomized controlled trials in white populations [2], [3] and in Asians [4], [5], [6], [7] have successfully demonstrated that by controlling these lifestyle risk factors, it is possible to prevent or postpone development of type 2 diabetes in prediabetic participants. In western populations, the beneficial changes were largely associated with weight reduction [2], [3], whereas in Asian populations the benefit of lifestyle intervention occurred independent of weight loss [4], [6], [7]. The components of lifestyle intervention that are responsible for the reduced incidence of diabetes have not been studied in detail in Asian Indians and this analysis has focused on this aspect.

Section snippets

Materials and methods

The present analysis is based on a primary prevention trial done in a cohort of Asian Indian men with impaired glucose tolerance (IGT) at baseline in south-east India between August 10, 2009, and November 30, 2012 [7]. The study design, methods, recruitment and characteristics of the study participants have been reported previously [7]. Briefly, all the participants had IGT at baseline on an initial testing with a 2 h post glucose capillary blood glucose followed by a confirmatory oral glucose

Results

At the end of the study, among the 537 participants recruited for the study, 517 (96%; standard care advice: n = 256; intervention: n = 261) responded for the final follow-up. They were included for the present analysis. Mean age and BMI were 46.0 ± 4.7 years and 25.8 ± 3.1 kg/m² respectively. The changes in dietary habits and regular physical activity at the end of the study are shown in Table 1. Higher percentage of persons in the intervention reported changes in dietary habits compared with the

Discussion

Good adherence to the lifestyle goals resulted in the beneficial outcome of lower incidence of T2DM in the intervention group in comparison with the control group. The outcome of lifestyle modification was more pronounced among participants who achieved higher lifestyle scores; on the other hand, the failure to make any changes resulted in an increased incidence of diabetes in either group. Compliance to the healthy dietary habits and regular physical activity improved insulin sensitivity and

Author contributions

J. Ram, S. Selvam, C. Snehalatha, D.G. Johnston and A. Ramachandran researched data, contributed to discussion, wrote manuscript, reviewed/edited manuscript; A. Nanditha and Mary Simon researched data, reviewed/edited manuscript; Samith A. Shetty and I.F. Godsland contributed to discussion, reviewed/edited manuscript.

Conflicts of interest

DGJ is supported by the UK National Institute for Health Research (NIHR). Imperial College London is grateful for support from the NIHR Collaboration for Leadership in Applied Health Research and Care and the Imperial NIHR Biomedical Research Centre. The authors declare that they have no conflicts of interest.

Funding

This work was funded by the UK India Education and Research Initiative (IND/CONT/06-07/187E). We also acknowledge the partial funding given by the World Diabetes Foundation (WDF) for the study (WDF 08-406).

Acknowledgments

The authors acknowledge the statistical help and secretarial assistance rendered by Ms. L. Vijaya.

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View full text

Improvement in diet habits, independent of physical activity helps to reduce incident diabetes among prediabetic Asian Indian men

Abstract

Aims

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Author contributions

Conflicts of interest

Funding

Acknowledgments

Diabetes Res Clin Pract

Lancet Diabetes Endocrinol

Lancet

Behavioral and dietary risk factors for noncommunicable diseases

N Engl J Med

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

N Engl J Med

Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance

N Engl J Med

Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study

Diabetes Care

The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1)

Diabetologia