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Incidence of type 2 diabetes in the randomized multiple risk factor intervention trial.
Ann Intern Med 2005; 142(5):313-22AIM

Abstract

BACKGROUND

Weight loss and increased physical exercise reduce the risk for diabetes in people with impaired glucose tolerance. Randomized trial evidence on the effect of these interventions on people without impaired glucose tolerance is lacking.

OBJECTIVE

To examine the influence of a comprehensive intervention program on the risk for developing diabetes in men without impaired glucose tolerance and in a post hoc subgroup analysis by baseline cigarette smoking status.

DESIGN

Randomized, controlled trial.

SETTING

22 clinical centers for the Multiple Risk Factor Intervention Trial (MRFIT).

PARTICIPANTS

12,866 men age 35 to 57 years at risk for cardiovascular disease were randomly assigned to either a special intervention or usual care group and followed for 6 to 7 years; this report focuses on 11,827 men without diabetes or impaired glucose tolerance at entry for whom follow-up glucose measurements were available.

MEASUREMENTS

Cardiovascular disease risk factors, fasting blood glucose levels, and diabetes medication history were assessed before randomization and annually.

INTERVENTION

Men in the special intervention group were counseled to change diet (reduce saturated fat, cholesterol, and calorie intake), to stop smoking, and to increase physical activity. Blood pressure was treated more intensively in the special intervention group than in the usual care group.

RESULTS

11.5% of the special intervention group and 10.8% of the usual care group developed diabetes over 6 years of follow-up (hazard ratio, 1.08 [95% CI, 0.96 to 1.20]). The special intervention-usual care hazard ratio for diabetes was 1.26 (CI, 1.10 to 1.45) among smokers (63%) and 0.82 (CI, 0.68 to 0.98) among nonsmokers (37%). These estimates differed significantly (P = 0.0003). Weight gain after smoking cessation and the use of antihypertensive drugs may have counterbalanced the beneficial effect of the lifestyle intervention for the special intervention group smokers, while the lifestyle intervention was beneficial among nonsmokers.

LIMITATIONS

Principal findings are based on a post hoc subgroup analysis.

CONCLUSIONS

In nonsmokers, an intervention program that included nutrition counseling to produce reductions in weight, serum cholesterol, and (along with antihypertensive medication) blood pressure reduced the risk for diabetes.

Authors+Show Affiliations

Department of Social Medicine, University of Bristol, Bristol, United Kingdom. zetkin@bristol.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15738450

Citation

Davey Smith, George, et al. "Incidence of Type 2 Diabetes in the Randomized Multiple Risk Factor Intervention Trial." Annals of Internal Medicine, vol. 142, no. 5, 2005, pp. 313-22.
Davey Smith G, Bracha Y, Svendsen KH, et al. Incidence of type 2 diabetes in the randomized multiple risk factor intervention trial. Ann Intern Med. 2005;142(5):313-22.
Davey Smith, G., Bracha, Y., Svendsen, K. H., Neaton, J. D., Haffner, S. M., & Kuller, L. H. (2005). Incidence of type 2 diabetes in the randomized multiple risk factor intervention trial. Annals of Internal Medicine, 142(5), pp. 313-22.
Davey Smith G, et al. Incidence of Type 2 Diabetes in the Randomized Multiple Risk Factor Intervention Trial. Ann Intern Med. 2005 Mar 1;142(5):313-22. PubMed PMID: 15738450.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of type 2 diabetes in the randomized multiple risk factor intervention trial. AU - Davey Smith,George, AU - Bracha,Yiscah, AU - Svendsen,Kenneth H, AU - Neaton,James D, AU - Haffner,Steven M, AU - Kuller,Lewis H, AU - ,, PY - 2005/3/2/pubmed PY - 2005/3/10/medline PY - 2005/3/2/entrez SP - 313 EP - 22 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 142 IS - 5 N2 - BACKGROUND: Weight loss and increased physical exercise reduce the risk for diabetes in people with impaired glucose tolerance. Randomized trial evidence on the effect of these interventions on people without impaired glucose tolerance is lacking. OBJECTIVE: To examine the influence of a comprehensive intervention program on the risk for developing diabetes in men without impaired glucose tolerance and in a post hoc subgroup analysis by baseline cigarette smoking status. DESIGN: Randomized, controlled trial. SETTING: 22 clinical centers for the Multiple Risk Factor Intervention Trial (MRFIT). PARTICIPANTS: 12,866 men age 35 to 57 years at risk for cardiovascular disease were randomly assigned to either a special intervention or usual care group and followed for 6 to 7 years; this report focuses on 11,827 men without diabetes or impaired glucose tolerance at entry for whom follow-up glucose measurements were available. MEASUREMENTS: Cardiovascular disease risk factors, fasting blood glucose levels, and diabetes medication history were assessed before randomization and annually. INTERVENTION: Men in the special intervention group were counseled to change diet (reduce saturated fat, cholesterol, and calorie intake), to stop smoking, and to increase physical activity. Blood pressure was treated more intensively in the special intervention group than in the usual care group. RESULTS: 11.5% of the special intervention group and 10.8% of the usual care group developed diabetes over 6 years of follow-up (hazard ratio, 1.08 [95% CI, 0.96 to 1.20]). The special intervention-usual care hazard ratio for diabetes was 1.26 (CI, 1.10 to 1.45) among smokers (63%) and 0.82 (CI, 0.68 to 0.98) among nonsmokers (37%). These estimates differed significantly (P = 0.0003). Weight gain after smoking cessation and the use of antihypertensive drugs may have counterbalanced the beneficial effect of the lifestyle intervention for the special intervention group smokers, while the lifestyle intervention was beneficial among nonsmokers. LIMITATIONS: Principal findings are based on a post hoc subgroup analysis. CONCLUSIONS: In nonsmokers, an intervention program that included nutrition counseling to produce reductions in weight, serum cholesterol, and (along with antihypertensive medication) blood pressure reduced the risk for diabetes. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/15738450/full_citation L2 - https://www.annals.org/article.aspx?volume=142&issue=5&page=313 DB - PRIME DP - Unbound Medicine ER -