Study finds people with high-risk prediabetes benefit from lifestyle intervention

 In particular, individuals with prediabetes at the highest risk benefited from intensive lifestyle intervention. The study by the German Center for Diabetes Research (DZD) was conducted at 8 sites of the centre throughout Germany. More exercise and healthy eating behaviour help many people with prediabetes to normalise their blood glucose levels and avoid developing type 2 diabetes. 

However, not everyone benefits from a conventional lifestyle intervention (LI). Recent studies show that already in prediabetes, there are different subtypes with different risk profiles. Researchers at the German Center for Diabetes Research (DZD) have therefore investigated in a multicenter randomised controlled trial whether people with prediabetes and a high-risk benefit from an intensification of the intervention and how people with low risk are affected by a conventional LI compared to no lifestyle changes.

The LI lasted 12 months in each case and the follow-up period was a further two years. A total of 1,105 individuals with prediabetes were investigated at various study sites in Germany and assigned to a high-risk or low-risk phenotype based on insulin secretion, insulin sensitivity, and liver fat content. 82 per cent of participants completed the study. People at high risk  these individuals produce too little insulin or suffer from the fatty liver with insulin resistance were randomly assigned to receive conventional LI according to the Diabetes Prevention Program (DPP) or a more intensive intervention with double the amount of required exercise. 

The results showed that more exercise, i.e. more intensive LI, helps people at high risk improve their blood glucose and cardiometabolic levels and reduce the liver fat content to within the normal range. Conventional LI is less effective. Low-risk participants completed a conventional LI or took part in a control group that received only a one-time brief consultation. "After three years, glucose tolerance was more likely to normalise in participants with conventional LI than in those in the control group," said Professor Hans-Ulrich Haring of the German Center for Diabetes Research and the last author of the study. There were hardly any differences in insulin sensitivity and secretion, liver fat content and cardiometabolic risk. 

"Our study results show that an individualised LI based on the risk phenotype is beneficial for diabetes prevention," said study leader Professor Andreas Fritsche from the Institute of Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tubingen (IDM) and the Department of Diabetology, Endocrinology and Nephrology (Director: Professor Andreas Birkenfeld, MD) at Tubingen University Hospital, summarising the results. "For successful prevention, we need to identify high-risk patients in the future and focus on providing them with an intensified lifestyle intervention."