University of Oulu

Reeta Rintamäki, Nina Rautio, Markku Peltonen, Jari Jokelainen, Sirkka Keinänen-Kiukaanniemi, Heikki Oksa, Timo Saaristo, Hannu Puolijoki, Juha Saltevo, Jaakko Tuomilehto, Matti Uusitupa, Leena Moilanen, Long-term outcomes of lifestyle intervention to prevent type 2 diabetes in people at high risk in primary health care, Primary Care Diabetes, Volume 15, Issue 3, 2021, Pages 444-450, ISSN 1751-9918,

Long-term outcomes of lifestyle intervention to prevent type 2 diabetes in people at high risk in primary health care

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Author: Rintamäki, Reeta1; Rautio, Nina2,3; Peltonen, Markku4;
Organizations: 1Department of Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
2Centre for Life Course Health Research, University of Oulu, Oulu, Finland
3Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
4Public Health Prevention Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
5Infrastructure for Populations Studies, University of Oulu, Oulu, Finland
6Healthcare and Social Services of Selänne, Pyhäjärvi, Finland
7Tampere University Hospital, Tampere, Finland
8Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
9Central Finland Central Hospital, Jyväskylä, Finland
10Department of Public Health, University of Helsinki, Helsinki, Finland
11Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
12Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
Persistent link:
Language: English
Published: Elsevier, 2021
Publish Date: 2022-01-17


Aims: The Finnish National Diabetes Prevention Program (FIN-D2D) was the first large-scale diabetes prevention program in a primary health care setting in the world. The risk reduction of type 2 diabetes was 69% after one-year intervention in high-risk individuals who were able to lose 5% of their weight. We investigated long-term effects of one-year weight change on the incidence of type 2 diabetes, cardiovascular events, and all-cause mortality.

Methods: A total of 10,149 high-risk individuals for type 2 diabetes were identified in primary health care centers and they were offered lifestyle intervention to prevent diabetes. Of these individuals who participated in the baseline screening, 8353 had an oral glucose tolerance test (OGTT). Complete follow-up data during one-year intervention were available for 2730 individuals and those were included in the follow-up analysis. The long-term outcome events were collected from national health registers after the median follow-up of 7.4 years.

Results: Among individuals who lost weight 2.5−4.9% and 5% or more during the first year, the hazard ratio for the incidence of drug-treated diabetes was 0.63 (95% CI 0.49−0.81, p = 0.0001), and 0.71 (95% CI 0.56−0.90, p = 0.004), respectively, compared with those with stable weight. There were no significant differences in cardiovascular events or all-cause mortality among study participants according to one-year weight changes.

Conclusions: High-risk individuals for type 2 diabetes who achieved a moderate weight loss by one-year lifestyle counseling in primary health care had a long-term reduction in the incidence of drug-treated type 2 diabetes. The observed moderate weight loss was not associated with a reduction in cardiovascular events.

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Series: Primary care diabetes
ISSN: 1751-9918
ISSN-E: 1878-0210
ISSN-L: 1751-9918
Volume: 15
Issue: 3
Pages: 444 - 450
DOI: 10.1016/j.pcd.2021.03.002
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: RR is supported by Finnish Government Research Funding. The FIN-D2D programme was supported by financing from hospital districts of Pirkanmaa, Southern Ostrobothnia, North Ostrobothnia, Central Finland and Northern Savo, the Finnish National Public Health Institute, the Finnish Diabetes Association, the Ministry of Social Affairs and Health in Finland, Finland's Slottery Machine Association, the Academy of Finland (grant no. 129293) and Commission of the European Communities, Directorate C-Public Health (grant agreement no. 2004310) in cooperation with the FIN-D2D Study Group, and the Steering Committee: Huttunen J, Kesäniemi A, Kiuru S, Niskanen L, Oksa H, Pihlajamäki J, Puolakka J, Puska P, Saaristo T, Vanhala M, and Uusitupa M. The funding organizations (except for the hospital districts) had no role in the design and conduct of the study; the collection management, analysis and interpretation of data, or the writing of the manuscript for publication.
Copyright information: © 2021 The Authors. Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe. This is an open access article under the CC BY-NC-ND license (http://