Raj S Bhopal1, Anne Douglas2, Sunita Wallia2, John F Forbes2, Michael E J Lean3, Jason M R Gill3, John A McKnight4, Naveed Sattar3, Aziz Sheikh5, Sarah H Wild2, Jaakko Tuomilehto6, Anu Sharma2, Ruby Bhopal2, Joel B E Smith7, Isabella Butcher2, Gordon D Murray2. 1. Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK. Electronic address: raj.bhopal@ed.ac.uk. 2. Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK. 3. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. 4. Metabolic Unit, Anne Ferguson Building, Western General Hospital, Edinburgh, UK. 5. Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 6. Centre for Vascular Prevention, Danube-University Krems, Krems, Austria; Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; King Abdulaziz University, Jeddah, Saudi Arabia. 7. Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK.
Abstract
BACKGROUND: The susceptibility to type 2 diabetes of people of south Asian descent is established, but there is little trial-based evidence for interventions to tackle this problem. We assessed a weight control and physical activity intervention in south Asian individuals in the UK. METHODS: We did this non-blinded trial in two National Health Service (NHS) regions in Scotland (UK). Between July 1, 2007, and Oct 31, 2009, we recruited men and women of Indian and Pakistani origin, aged 35 years or older, with waist circumference 90 cm or greater in men or 80 cm or greater in women, and with impaired glucose tolerance or impaired fasting glucose determined by oral glucose tolerance test. Families were randomised (using a random number generator program, with permuted blocks of random size, stratified by location [Edinburgh or Glasgow], ethnic group [Indian or Pakistani], and number of participants in the family [one vs more than one]) to intervention or control. Participants in the same family were not randomised separately. The intervention group received 15 visits from a dietitian over 3 years and the control group received four visits in the same period. The primary outcome was weight change at 3 years. Analysis was by modified intention to treat, excluding participants who died or were lost to follow-up. We used linear regression models to provide mean differences in baseline-adjusted weight at 3 years. This trial is registered, number ISRCTN25729565. FINDINGS: Of 1319 people who were screened with an oral glucose tolerance test, 196 (15%) had impaired glucose tolerance or impaired fasting glucose and 171 entered the trial. Participants were in 156 family clusters that were randomised (78 families with 85 participants were allocated to intervention; 78 families with 86 participants were allocated to control). 167 (98%) participants in 152 families completed the trial. Mean weight loss in the intervention group was 1.13 kg (SD 4.12), compared with a mean weight gain of 0.51 kg (3.65) in the control group, an adjusted mean difference of -1.64 kg (95% CI -2.83 to -0.44). INTERPRETATION: Modest, medium-term changes in weight are achievable as a component of lifestyle-change strategies, which might control or prevent adiposity-related diseases. FUNDING: National Prevention Research Initiative, NHS Research and Development; NHS National Services Scotland; NHS Health Scotland.
BACKGROUND: The susceptibility to type 2 diabetes of people of south Asian descent is established, but there is little trial-based evidence for interventions to tackle this problem. We assessed a weight control and physical activity intervention in south Asian individuals in the UK. METHODS: We did this non-blinded trial in two National Health Service (NHS) regions in Scotland (UK). Between July 1, 2007, and Oct 31, 2009, we recruited men and women of Indian and Pakistani origin, aged 35 years or older, with waist circumference 90 cm or greater in men or 80 cm or greater in women, and with impaired glucose tolerance or impaired fasting glucose determined by oral glucose tolerance test. Families were randomised (using a random number generator program, with permuted blocks of random size, stratified by location [Edinburgh or Glasgow], ethnic group [Indian or Pakistani], and number of participants in the family [one vs more than one]) to intervention or control. Participants in the same family were not randomised separately. The intervention group received 15 visits from a dietitian over 3 years and the control group received four visits in the same period. The primary outcome was weight change at 3 years. Analysis was by modified intention to treat, excluding participants who died or were lost to follow-up. We used linear regression models to provide mean differences in baseline-adjusted weight at 3 years. This trial is registered, number ISRCTN25729565. FINDINGS: Of 1319 people who were screened with an oral glucose tolerance test, 196 (15%) had impaired glucose tolerance or impaired fasting glucose and 171 entered the trial. Participants were in 156 family clusters that were randomised (78 families with 85 participants were allocated to intervention; 78 families with 86 participants were allocated to control). 167 (98%) participants in 152 families completed the trial. Mean weight loss in the intervention group was 1.13 kg (SD 4.12), compared with a mean weight gain of 0.51 kg (3.65) in the control group, an adjusted mean difference of -1.64 kg (95% CI -2.83 to -0.44). INTERPRETATION: Modest, medium-term changes in weight are achievable as a component of lifestyle-change strategies, which might control or prevent adiposity-related diseases. FUNDING: National Prevention Research Initiative, NHS Research and Development; NHS National Services Scotland; NHS Health Scotland.
Authors: Anne Karen Jenum; Idunn Brekke; Ibrahimu Mdala; Mirthe Muilwijk; Ambady Ramachandran; Marte Kjøllesdal; Eivind Andersen; Kåre R Richardsen; Anne Douglas; Genevieve Cezard; Aziz Sheikh; Carlos A Celis-Morales; Jason M R Gill; Naveed Sattar; Raj S Bhopal; Erik Beune; Karien Stronks; Per Olav Vandvik; Irene G M van Valkengoed Journal: Diabetologia Date: 2019-06-15 Impact factor: 10.122