Intensification of lifestyle intervention improves glycemic control and cardiometabolic profile in high risk prediabetic persons, according to the multicenter Prediabetes Lifestyle Intervention Study (PLIS) published in the journal Diabetes.

Researchers at the German Center for Diabetes Research (DZD) investigated the impact of lifestyle intervention on 908 persons with prediabetes, who were further categorized into high-risk or low-risk phenotypes. The liver fat content, insulin secretion and insulin sensitivity were measured and used for risk stratification.

Individuals with low risk were assigned to conventional lifestyle intervention (LT-CONV) according to the Diabetes Prevention Program (DPP) protocol or to a control group with no lifestyle intervention (LT-CTRL), while those at high risk were subject to intensive lifestyle intervention (HR-INT) or conventional lifestyle intervention (HR-CONV) with double the amount of exercise (6 hours per week vs 3 hours per week). The duration of the intervention was one year and the participants were followed for a further period of two years.

Results showed that blood glucose levels improved (-0.29 mmol/L) among the high-risk individuals assigned to a more intensive lifestyle intervention compared to conventional lifestyle intervention. The reduction of liver fat was 6.6% in the HR-INT group vs 8.3 % in the HR-CONV group. Improvement in cardiovascular risk was also observed in the HR-INT group compared to the HR-CONV group. Among the low-risk individuals, those assigned to conventional lifestyle intervention had higher probability of normalizing their glucose tolerance compared to the control group.

Lifestyle modification is quite often the first line treatment of persons with type 2 diabetes. It acts complementary to antidiabetic medications in preventing or delaying the macro- and microvascular complications. Prediabetes is a manifestation of poor lifestyle behavior and around 70% of individuals with prediabetes will go on to develop diabetes in due course of time. Lifestyle modification is the cornerstone of management to prevent or reduce progression to diabetes (40-70% relative risk reduction). 

This study recapitulates the beneficial effects of lifestyle intervention in improving glycemic control. But it also proposes that the risk phenotype of the individual influences the response to lifestyle intervention. The authors write, “This nonresponse can be partially compensated with intensified LI such that a higher percentage of HR individuals improve glucose metabolism and decrease liver fat content and cardiovascular risk”. Therefore, a lifestyle intervention plan based on the individual risk phenotype of the patient may be more successful in achieving the desired clinical outcomes.

References

1. Fritsche A, et al. Different effects of lifestyle intervention in high- and low-risk prediabetes: results of the randomized controlled Prediabetes Lifestyle Intervention Study (PLIS). Diabetes. 2021 Dec;70(12):2785-2795. doi: 10.2337/db21-0526.
2. Tabák AG, et al. Prediabetes: a high-risk state for diabetes development. Lancet. 2012 Jun 16;379(9833):2279-90. doi: 10.1016/S0140-6736(12)60283-9.