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

Abstract

OBJECTIVE To 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 METHODS This post hoc analysis of the multicenter, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around theWorld (PREVIEW), included 1,510 participants with prediabetes (BMI ≥25 kg · m−2; 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 · mol−1). Participants underwent an 8-week diet-induced rapid weight loss, followed by a 148-week lifestyle-based weight maintenance intervention. Linearmixedmodels adjusted for intervention armand other confounders were used. RESULTS In 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 (mean22.5% [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. Participantswith 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 · L−1 [95% CI 20.70, 20.39], P 0.001), and triglycerides (difference 20.07 mmol · L−1 [20.11, 20.03], P 0.001) during the lifestyle intervention. CONCLUSIONS Individuals 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.