Long-term effectiveness of a lifestyle intervention for the primary prevention of type 2 diabetes in a low socio-economic community - an intervention follow-up study on reunion island

Abstract

In type 2 diabetes (T2D) prevention research, evidence for maintenance of risk factor reduction after three years of follow-up is needed. The objective of this study was to evaluate the long-termeffectiveness of a combined lifestyle intervention aiming at controlling body weight (BW) and waist circumference (WC) in non-diabetic, overweight/obese adults living in a low socio-economic community. On Reunion Island, 445 adults living in deprived areas, aged 18-40 and at high-risk for T2D, were included in an intervention versus control trial for primary prevention (2001-2002). The intervention promoted a healthy diet and moderate regular physical activity, through actions strengthening individuals or community and improving living conditions. The control group received a one-shotmedical information and nutritional advices. After the end of the trial (2003), 259 of the subjects participated in a follow-up study (2010- 2011). The outcomes were the nine-year changes from baseline in BW, bodymass index (BMI) and WCmeasurements, separately. Statistical analyses were performed on an intention-to-treat basis, using available and imputed datasets. At inclusion, T2D risk factors were prevalent: family history of diabetes in first-degree relatives (42%), women with a personal history of gestational diabetes (11%), total obesity (43%, median BMI 29.1 kg/m) and central obesity (71%). At follow-up, the adjusted effect on imputed dataset was significant forWC-2.4 cm (95% confidence interval:-4.7 to-0.0 cm, p = 0.046), non-significant for BW-2.2 kg (-4.6 to +0.2 kg, p = 0.073) and BMI-0.81 kg/m (-1.69 to +0.08 kg/m, p = 0.074). A specific long-termeffect was the increased likelihood of reduction in adiposity: BWloss, BMI reduction, and WCreduction were more frequent in the intervention group. In the context of low socio-economic communities, our data support the assumption of long-term effect of lifestyle interventions targeting total obesity and central obesity two major drivers of T2D.