DELIGHT (Delay of impaired glucose tolerance by a healthy lifestyle trial) – A Feasibility Study on Implementing a Program of Sustainable Diabetes Prevention in German Companies

B.-C. Zyriax; B. Letsch; S. Stock; E. Windler

doi:10.1055/s-0033-1355423

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2014; 122(1): 20-26
DOI: 10.1055/s-0033-1355423

Article

DELIGHT (Delay of impaired glucose tolerance by a healthy lifestyle trial) – A Feasibility Study on Implementing a Program of Sustainable Diabetes Prevention in German Companies

B.-C. Zyriax

¹Endocrionology and Metabolism of Aging, University Hospital Hamburg-Eppendorf

,

B. Letsch

²AOK NordWest, Kiel

,

S. Stock

³Cologne Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne

,

E. Windler

¹Endocrionology and Metabolism of Aging, University Hospital Hamburg-Eppendorf

› Author Affiliations

Abstract

Background:

Ca. 50% of Germans develop prediabetes in their lifetime. Though diabetes type 2 has been proven preventable, no screening for prediabetes has been implemented. DELIGHT was designed to assess if screening for individuals at risk and long-standing diabetes prevention is feasible in the setting of companies within the scope of the German legal health system.

Materials and Methods:

In 5 companies employees with a waist circumference of ≥ 94 (men) and ≥ 80 cm (women) were offered a check-up. Those with fasting plasma glucose ≥ 100 mg/dl (IFG) or ≥ 140 mg/dl 2 h after oral glucose load (IGT) were followed for 3 years with an optional moderate lifestyle program during the first year and quarterly assistance for another 2 years.

Results:

In 241 of 300 participants the self-measured waist circumference was confirmed as elevated. 3% had type 2 diabetes, while 37% had IFG (isolated in 96%) or IGT, of whom 91.4% (men) and 76.1% (women) had a metabolic syndrome. Within 3 years in those who had lost ≥ 1 kg, weight was reduced by 3.9 kg, risk factors were improved, and no case of diabetes had developed, while among those with weight loss of < 1 kg or weight gain, 10% of men and 5% of women had developed diabetes type 2. Screening for prediabetes did not increase the number or costs of drug prescriptions.

Conclusions:

Companies provide a suitable setting for screening for prediabetes. Long-term diabetes prevention is successfully feasible within the narrow financial frame of a legal insurance system without rise of costs.

Key words

prediabetes - diabetes type 2 - prevention - setting - nutrition - physical activity

Full Text

References

References
1 Wild S, Roglic G, Green A et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047-1053
2 Romero-Corral A, Somers VK, Sierra-Johnson J et al. Normal weight obesity: a risk factor for cardiometabolic dysregulation and cardiovascular mortality. Eur Heart J 2010; 31: 737-746
3 Heidemann C, Du Y, Scheidt-Nave C. Diabetes mellitus in Deutschland ed. Robert Koch-Institut Berlin. GBE kompakt 2 (3) www.rki.de/gbe-kompakt
4 Genuth S, Alberti KGMM, Bennett P et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26: 3160-3167
5 de Vegt F, Dekker JM, Jager A et al. Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: the Hoorn Study. JAMA 2001; 285: 2109-2113
6 Diabetes Prevention Program (DPP) Research Group . The Diabetes Prevention Program (DPP) description of lifestyle intervention. Diabetes Care 2002; 25: 2165-2171
7 Edelstein SL, Knowler WC, Bain RP et al. Predictors of progression from impaired glucose tolerance to NIDDM: an analysis of six prospective studies. Diabetes 1997; 46: 701-710
8 Morris DH, Khunti K, Achana F et al. Progression rates from HbA1c 6.0-6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis. Diabetologia 2013; 56: 148-1493
9 Nijpels G, Boorsma W, Dekker JM et al. Absence of an acute insulin response predicts onset of type 2 diabetes in a Caucasian population with impaired glucose tolerance. J Clin Endocrinol Metab 2008; 93: 2633-2638
10 Rathmann W, Haastert B, Icks A et al. High Prevalence of Undiagnosed Diabetes Mellitus in Southern Germany: Target Populations for Efficient Screening – The KORA Survey 2000. Diabetologia 2003; 46: 182-189
11 Meisinger C, Strassburger K, Heier M et al. Prevalence of undiagnosed diabetes and impaired glucose regulation in 35-59-year-old individuals in Southern Germany: the KORA F4 Study. Diabet Med 2010; 27: 360-362
12 Elobeid MA, Desmond RA, Thomas O et al. Waist circumference values are increasing beyond those expected from BMI increases. Obesity (Silver Spring) 2007; 15: 2380-2383
13 Lindström J, Peltonen M, Eriksson JG et al. High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish Diabetes Prevention Study. Diabetologia 2006; 49: 912-920
14 Brotman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. Lancet 2007; 370: 1089-1100
15 Tuomilehto J, Lindström J, Eriksson JG et al. Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343-1350
16 The Diabetes Prevention Program Research Group . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403
17 Kosaka K, Noda M, Kuzuya T. Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diabetes Res Clin Pract 2005; 67: 152-162
18 Li G, Zhang P, Wang J et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 2008; 371: 1783-1789
19 Lindström J, Ilanne-Parikka P, Peltonen M et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow up of the Finnish Diabetes Prevention Study. Lancet 2006; 368: 1673-1679
20 Diabetes Prevention Program Research Group . Knowler WC, Fowler SE, Hamman RF et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009; 374: 1677-1686
21 Schulze MB, Kroke A, Saracci R et al. The effect of differences in measurement procedure on the comparability of blood pressure estimates in multi-centre studies. Blood Press Monit 2002; 7: 95-104
22 Marques-Vidal P, Mazoyer E, Bongard V et al. Prevalence of insulin resistance syndrome in southwestern France and its relationship with inflammatory and hemostatic markers. Diabetes Care 2002; 25: 1371-1377
23 Boeing H, Wahrendorf J, Becker N. EPIC-Germany – A Source for Studies into Diet and Risk of Chronic Diseases. Ann Nutr Metab 1999; 43: 195-204
24 National Cholesterol Education Program (NCEP) Expert Panel . Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Executive Summary. NIH Publication 2001; 01-3670
25 Emerging Risk Factors Collaboration . Seshasai SR, Kaptoge S, Thompson A et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 2011; 364: 829-841
26 Franco M, Orduñez P, Caballero B et al. Impact of energy intake, physical activity, and population-wide weight loss on cardiovascular disease and diabetes mortality in Cuba, 1980-2005. Am J Epidemiol 2007; 166: 1374-1380
27 Hopper I, Billah B, Skiba M et al. Prevention of diabetes and reduction in major cardiovascular events in studies of subjects with prediabetes: meta-analysis of randomised controlled clinical trials. Eur J Cardiovasc Prev Rehabil 2011; 18: 813-823
28 Rijkelijkhuizen JM, Nijpels G, Heine RJ et al. High risk of cardiovascular mortality in individuals with impaired fasting glucose is explained by conversion to diabetes: the Hoorn study. Diabetes Care 2007; 30: 332-336
29 Zyriax B-Chr, Wolf C, Schlüter A, Khattak AH et al. Association of cognitive dietary restraint and disinhibition with prediabetes – cross-sectional and longitudinal data of a feasibility study in German employees. Public Health Nutr 2011; 29: 1-8
30 Siegel LC, Sesso HD, Bowman TS et al. Physical Activity, Body Mass Index, and Diabetes Risk in Men: A Prospective Study. Am J Med 2009; 122: 1115-1121
31 Hu G, Lindström J, Valle TT et al. Physical Activity, Body Mass Index, and Risk of Type 2 Diabetes in Patients With Normal or Impaired Glucose Regulation. Arch Intern Med 2004; 164: 892-896
32 Alvarsson M, Hilding A, Ostenson CG. Factors determining normalization of glucose intolerance in middle-aged Swedish men and women: a 8–10-year follow-up. Diabet Med 2009; 26: 345-353
33 Schienkiewitz A, Schulze MB, Hoffmann K et al. Body mass index history and risk of type 2 diabetes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Am J Clin Nutr 2006; 84: 427-433
34 Zyriax BC, Schoeffauer M, Klipstein-Grobusch K et al. Differential association of anthropometric parameters with coronary risk in women – data of the CORA study. Obes Facts 2011; 4: 358-364
35 Barr EL, Zimmet PZ, Welborn TA et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation 2007; 116: 151-157
36 Emerging Risk Factors Collaboration . Sarwar N, Gao P, Seshasai SR et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375: 2215-2222