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
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 multi-center, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World (PREVIEW), included 1510 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 HbA1c (<39 mmol·mol-1) 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. Linear mixed models adjusted for intervention arm and other confounders were used.
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 -3.5% [95%CI, -4.7%, -2.3%]) than those with iIFG (mean -2.5% [-3.6%, -1.3%]) relative to baseline (P=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. Participants with normal vs intermediate HbA1c had similar WL over 3 years and minor differences in cardiometabolic benefits during weight loss, whereas those with normal HbA1c had greater improvements in fasting glucose, 2-hour glucose (adjusted between-group difference at 156 weeks -0.54 mmol·L-1 [-0.70, -0.39]; P<0.001), and triglycerides (difference -0.07 mmol·L-1 [-0.11, -0.03]; P<0.001) during the lifestyle intervention.
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.