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A lifestyle intervention in primary care prevents deterioration of insulin resistance in patients with impaired glucose tolerance: A randomised controlled trial.

Journal article
Authors Margareta Hellgren
Per-Anders Jansson
Hans Wedel
Ulf Lindblad
Published in Scandinavian journal of public health
Volume 44
Issue 7
Pages 718-725
ISSN 1651-1905
Publication year 2016
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Medicine
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 718-725
Language en
Links dx.doi.org/10.1177/1403494816663539
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Public health science, Clinical Medicine

Abstract

We hypothesised that the expected increase in insulin resistance over three years' time in individuals with impaired glucose tolerance (IGT) and/or impaired fasting glucose could be attenuated by an intervention with focus on physical activity in ordinary primary care.We conducted a randomised controlled trial with 96 participants over three years. Examination of the participants included anthropometric measures, blood pressure, body weight and height, blood samples, an oral glucose tolerance test, and questionnaires about diet and lifestyle. The study subjects were randomised to either an intense intervention with information, group sessions, referral to physical activity and a step-counter (n = 31), a less intense intervention without the group sessions (n = 35), or care as usual group (CAUG) (n = 30). Differences between the groups were analysed with general linear models adjusted for age, gender, baseline values and time in the intervention.Individual insulin resistance increased in the CAUG. Due to having a similar effect, we combined the two intervention groups into a combined intervention group (CIG; n = 66) in the analyses. In individuals with IGT, the increase in the homeostatic model assessment-insulin resistance differed significantly between those in the CAUG and the CIG (Δ = 0.8; CI: 0.1-1.6; p = 0.034). Likewise, diastolic blood pressure decreased more in the CIG than in the CAUG (Δ = 5.1; CI: 0.1-10.0; p = 0.047). A total of 17 individuals developed Type 2 diabetes, 23% were in the CIG and 33% in the CAUG; so there was a 32% reduced risk in the intervention group. CONCLUSIONS A LIFESTYLE INTERVENTION FOCUSED ON PHYSICAL ACTIVITY IS FEASIBLE IN ORDINARY PRIMARY CARE AND PREVENTS DETERIORATION IN INSULIN SENSITIVITY IN INDIVIDUALS WITH IGT OVER A THREE-YEAR PERIOD.

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