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Does the Effect of a 3-Year Lifestyle Intervention on Body Weight and Cardiometabolic Health Differ by Prediabetes Metabolic Phenotype? A Post Hoc Analysis of the PREVIEW Study

Ruixin Zhu, Elli Jalo, Marta P. Silvestre Orcid Logo, Sally D. Poppitt, Teodora Handjieva-Darlenska, Svetoslav Handjiev, Maija Huttunen-Lenz, Kelly Mackintosh Orcid Logo, Gareth Stratton Orcid Logo, Santiago Navas-Carretero, Kirsi H. Pietiläinen, Elizabeth Simpson, Ian A. Macdonald, Roslyn Muirhead, Jennie Brand-Miller, Mikael Fogelholm, Kristine Færch Orcid Logo, J. Alfredo Martinez, Margriet S. Westerterp-Plantenga, Tanja C. Adam Orcid Logo, Anne Raben Orcid Logo

Diabetes Care, Volume: 45, Issue: 11, Pages: 2698 - 2708

Swansea University Authors: Kelly Mackintosh Orcid Logo, Gareth Stratton Orcid Logo

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DOI (Published version): 10.2337/dc22-0549

Abstract

OBJECTIVETo examine whether the effect of a 3-year lifestyle intervention on body weight and cardiometabolic risk factors differs by prediabetes metabolic phenotype.RESEARCH DESIGN AND METHODSThis post hoc analysis of the multicenter, randomized trial, PREVention of diabetes through lifestyle interv...

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Published in: Diabetes Care
ISSN: 0149-5992 1935-5548
Published: American Diabetes Association 2022
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URI: https://cronfa.swan.ac.uk/Record/cronfa60245
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Abstract: OBJECTIVETo examine whether the effect of a 3-year lifestyle intervention on body weight and cardiometabolic risk factors differs by prediabetes metabolic phenotype.RESEARCH DESIGN AND METHODSThis post hoc analysis of the multicenter, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World (PREVIEW), included 1,510 participants with prediabetes (BMI ‡25 kg m22; defined using oral glucose tolerance tests). Of these, 58% had isolated impaired fasting glucose (iIFG), 6% had isolated impaired glucose tolerance (iIGT), and 36% had IFG+IGT; 73% had normal hemoglobin A1c (HbA1c; <39 mmol mol21) and 25% had intermediate HbA1c (39–47 mmol mol21). Participants underwent an 8-week diet-induced rapid weight loss, followed by a 148-week lifestyle-based weight maintenance intervention. Linear mixed models adjusted for intervention arm and other confounders were used.RESULTSIn the available-case and complete-case analyses, participants with IFG+IGT had greater sustained weight loss after lifestyle intervention (adjusted mean at 156 weeks 23.5% [95% CI, 24.7%, 22.3%]) than those with iIFG (mean 22.5% [23.6%, 21.3%]) relative to baseline (P 5 0.011). Participants with IFG+IGT and iIFG had similar cardiometabolic benefits from the lifestyle intervention. The differences in cardiometabolic benefits between those with iIGT and IFG+IGT were minor or inconsistent in different analyses. Participants with normal versus intermediate HbA1c had similar weight loss over 3 years and minor differences in cardiometabolic benefits during weight loss, whereas those with normal HbA1c had greater improvements in fasting glucose, 2-h glucose (adjusted between-group difference at 156 weeks 20.54 mmol L21 [95% CI 20.70, 20.39],P < 0.001), and triglycerides (difference 20.07 mmol L21 [20.11, 20.03], P < 0.001) during the lifestyle intervention.CONCLUSIONSIndividuals with iIFG and IFG+IGT had similar improvements in cardiometabolic health from a lifestyle intervention. Those with normal HbA1c had greater improvements than those with intermediate HbA1c.
College: Faculty of Science and Engineering
Issue: 11
Start Page: 2698
End Page: 2708