Institute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Diabetes Care. 2011 Feb;34(2):418-23. doi: 10.2337/dc10-1013. Epub 2010 Oct 27.
We aimed to investigate the influence of positive family history (FH+) of diabetes and 19 known genetic risk loci on the effectiveness of lifestyle changes and their predictive value on the incidence of type 2 diabetes in the Finnish Diabetes Prevention Study (DPS).
A total of 522 subjects with impaired glucose tolerance (IGT) were randomized into the control (n = 257) and intervention (n = 265) groups. The mean follow-up was 6.2 years (median 7 years), and the lifestyle intervention, aimed at weight reduction, healthy diet, and increased physical activity, lasted for 4 years (range 1-6 years). An oral glucose tolerance test (OGTT) and assessment of basic clinical variables were performed annually.
The effect of intervention on the incidence of diabetes was almost similar in subjects with FH+ compared with subjects with a negative family history (FH-) of diabetes during the entire follow-up. In the Cox model, including FH, genetic risk SNPs, and randomization group, and adjusted for the effects of age, sex, BMI, and study center, only lifestyle intervention had a significant effect (hazard ratio 0.55, 95% CI 0.41-0.75, P < 0.001) on the incidence of diabetes. Further analyses showed that in addition to the baseline glucose and insulin values, 1-year changes in 2-h glucose and 2-h insulin achieved by lifestyle intervention had a significant effect on the incidence of diabetes.
These results emphasize the effectiveness of lifestyle intervention in reducing the risk of diabetes in high-risk individuals independently of genetic or familial risk of type 2 diabetes.
本研究旨在探讨阳性糖尿病家族史（FH+）和 19 个已知遗传风险位点对生活方式改变效果的影响，以及其对芬兰糖尿病预防研究（DPS）中 2 型糖尿病发病率的预测价值。
共纳入 522 例糖耐量受损（IGT）患者，随机分为对照组（n = 257）和干预组（n = 265）。平均随访时间为 6.2 年（中位数 7 年），生活方式干预旨在减轻体重、健康饮食和增加身体活动，持续 4 年（范围 1-6 年）。每年进行口服葡萄糖耐量试验（OGTT）和基本临床变量评估。
在整个随访期间，与 FH-相比，FH+患者的干预效果对糖尿病发病率的影响几乎相似。在包括 FH、遗传风险 SNPs 和随机分组在内的 Cox 模型中，并调整年龄、性别、BMI 和研究中心的影响后，仅生活方式干预对糖尿病发病率有显著影响（风险比 0.55，95%CI 0.41-0.75，P < 0.001）。进一步分析表明，除了基线血糖和胰岛素值外，生活方式干预后 2 小时血糖和 2 小时胰岛素的 1 年变化对糖尿病发病率也有显著影响。
这些结果强调了生活方式干预在降低 2 型糖尿病高危个体糖尿病风险方面的有效性，独立于遗传或家族 2 型糖尿病风险。
