ArticlesCardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study
Introduction
Lifestyle interventions for people with impaired glucose tolerance can delay or prevent the development of diabetes and lead to improvements for other cardiovascular risk factors.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 However, whether these changes reduce the incidence of long-term complications, and the excess cardiovascular disease and all-cause mortality that accompany diabetes is uncertain.12, 13 In our previous analysis7 of 20-year follow-up data from the Da Qing Diabetes Prevention Study, we reported a statistically insignificant 17% reduction in cardiovascular disease mortality and a significantly lower incidence of severe diabetic retinopathy that seems to have been mediated primarily by delaying the onset of diabetes.14 Because cardiovascular disease is the major cause of excess mortality in people with impaired glucose tolerance, more definitive information about the effect of lifestyle intervention on cardiovascular disease and all-cause mortality in such people has crucial public health implications. We assessed such effects in people who participated in the Da Qing Diabetes Prevention Study over a 23-year period.
Section snippets
Study design and participants
The design of the Da Qing Diabetes Prevention Study and the 20-year follow-up study have been reported previously.1, 7, 14 In 1986, 33 primary care clinics in Da Qing, China serving 577 people with impaired glucose tolerance were enrolled into a cluster randomised trial. All patients treated at the clinics were eligible if they had impaired glucose tolerance in 1985. We did a 20-year follow-up study up to the end of 20067 and here report results after an additional 3 years. The institutional
Results
Of the original 577 study participants, one declined the baseline examination, eight had only a baseline examination, and 20 participants were lost to follow-up during the 6-year intervention period, mainly because of job relocation. During the subsequent 17 years after the intervention, only six participants were lost to follow-up. Thus, 542 participants (94%) had complete data for mortality and 568 (99%) contributed data to the analysis (figure 1). 563 participants (98%) had complete data for
Discussion
This study is the first randomised clinical trial to show that lifestyle intervention in people with impaired glucose tolerance reduces all-cause and cardiovascular disease mortality (panel). These findings seem to mainly be a result of lower mortality among women in the intervention group. The Malmo study13 showed lower mortality over a 12-year period in men with impaired glucose tolerance treated with lifestyle intervention compared with a group who received routine treatment, but the study
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