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Dietary changes in a diabetes prevention intervention among people with prediabetes: the Diabetes Community Lifestyle Improvement Program trial

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Abstract

Aims

Diabetes prevention interventions have been less successful in Asian Indians compared to other populations, which may be due in part to dietary differences. The objective of this study was to determine the impact of a diabetes prevention intervention on diet and risk of diabetes in Asian Indians at high risk.

Methods

Data were included from the Diabetes Community Lifestyle Improvement Program (D-CLIP), a randomized control trial to prevent diabetes in overweight/obese Asian Indian adults (20–65 years) with prediabetes. Respondents received standard treatment (control; n = 283) or a 6-month intervention (n = 295) that included education and support to reduce intakes of fat and total calories (kilocalories; kcal). Diet was ascertained using a food frequency questionnaire, and incident diabetes was determined from annual 2-h plasma glucose post-oral glucose tolerance test or biannual fasting plasma glucose.

Results

There were 485 (control 240; intervention 245) respondents with complete diet data at baseline. At 6 months, the intervention was associated with decreased intake of total energy (− 185.6 kcal/day; 95% CI − 353.6, − 17.5 kcal/day) and refined cereals (− 7.2 g/1000 kcal; 95% CI − 12.7, − 1.7 g/1000 kcal), and increased intakes of fruits and vegetables (33.4 g/1000 kcal; 95% CI 16.0, 50.8 g/1000 kcal). The intervention group was half (HR 0.49; 95% CI 0.25, 0.94) as likely to develop diabetes at 1 year, and the hazard was significantly attenuated (12.2%; P = 0.015) with adjustment for fruits and vegetable intake.

Conclusion

The D-CLIP decreased the total energy intake and increased the intakes of fruits and vegetables, and reduced the 1-year incidence of diabetes by half.

Trial registration

Clinicaltrails.gov # NCT01283308

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Acknowledgements

This project is supported by a BRiDGES grant from the International Diabetes Federation (LT07-115). BRiDGES, an International Diabetes Federation project, is supported by an educational grant from Lilly Diabetes. Additional support was provided by the Global Health Institute at Emory University. CNF received funding from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number R21DK105891. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. MBW received funding from two National Institute of Diabetes and Digestive and Kidney Diseases T32 Grants (5T3-2DK-007298-33 and T32-DK-007734-16). LRS received funding from the Human Health Molecules to Humankind program funded by the Burroughs Wellcome Fund grant (BWF 1008188). CNF was the primary author of the manuscript and conducted all analyses. HR oversaw data collection and participant management at the study site. LRS conducted the primary analysis. MBW, HR, KMVN, and VM designed the trial. MBW, HR, and RMA developed the lifestyle intervention curriculum. All authors contributed to the manuscript discussion, provided edits to the text, and reviewed and approved the manuscript. MVN and VM are co-primary investigators of the study and provided senior leadership and direction to the team. CNF is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, CNR 7036, Atlanta, GA, 30322, USA

    Christopher N. Ford, Mary Beth Weber, Lisa R. Staimez & K. M. Venkat Narayan

  2. Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialties Centre, Chennai, India

    Ranjit M. Anjana, Karthikeyan Lakshmi, Viswanathan Mohan & Ranjani Harish

Authors
  1. Christopher N. Ford
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  2. Mary Beth Weber
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  3. Lisa R. Staimez
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  4. Ranjit M. Anjana
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  5. Karthikeyan Lakshmi
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  6. Viswanathan Mohan
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  7. K. M. Venkat Narayan
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  8. Ranjani Harish
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Correspondence to Mary Beth Weber.

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No potential conflicts of interest relevant to this article were reported.

Ethical approval

All procedures performed in studies involving human participants were approved by the Emory University Institutional Review Board (IRB-00016503) and the Madras Diabetes Research Foundation Ethics Committee and were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All subjects provided informed consent.

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Managed by Massimo Porta.

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Ford, C.N., Weber, M.B., Staimez, L.R. et al. Dietary changes in a diabetes prevention intervention among people with prediabetes: the Diabetes Community Lifestyle Improvement Program trial. Acta Diabetol 56, 197–209 (2019). https://doi.org/10.1007/s00592-018-1249-1

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