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Prevention of type 2 diabetes in a primary healthcare setting: Three-year results of lifestyle intervention in Japanese subjects with impaired glucose tolerance

Naoki Sakane1*, Juichi Sato2, Kazuyo Tsushita3, Satoru Tsujii4, Kazuhiko Kotani15, Kokoro Tsuzaki1, Makoto Tominaga6, Shoji Kawazu7, Yuzo Sato8, Takeshi Usui9, Isao Kamae10, Toshihide Yoshida11, Yutaka Kiyohara12, Shigeaki Sato13, Hideshi Kuzuya1415 and Japan Diabetes Prevention Program (JDPP) Research Group the for

Author Affiliations

1 Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

2 Department of General Medicine, Nagoya University Hospital, Nagoya, Japan

3 Comprehensive Health Science Center, Aichi Health Promotion Foundation, Aichi, Japan

4 Diabetes Center, Tenri Yorozu-sodansho Hospital, Tenri, Japan

5 Department of Clinical Laboratory Medicine, Jichi Medical School, Tochigi, Japan

6 Division of Internal Medicine, Hananoki Hospital, Tochigi, Japan

7 Department of Diabetes and Metabolism,Marunouchi Hospital, The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan

8 Department of Health Science, Faculty of Psychological and Physical Science, Aichi Gakuin University, Aichi, Japan

9 Division of Endocrinology, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

10 JPMA Pharmacoeconomics Program, Graduate School of Health Management, Keio University, Fujisawa, Japan

11 Department of Diabetes and Metabolism, Kyoto City Hospital, Kyoto, Japan

12 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyusyu University, Fukuoka, Japan

13 Aino Hospital, Ibaraki, Japan

14 National Hospital Organization Kyoto Medical Center, Kyoto, Japan

15 Higashiyama Takeda Hospital, Kyoto, Japan

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BMC Public Health 2011, 11:40  doi:10.1186/1471-2458-11-40

Published: 17 January 2011



A randomized control trial was performed to test whether a lifestyle intervention program, carried out in a primary healthcare setting using existing resources, can reduce the incidence of type 2 diabetes in Japanese with impaired glucose tolerance (IGT). The results of 3 years' intervention are summarized.


Through health checkups in communities and workplaces, 304 middle-aged IGT subjects with a mean body mass index (BMI) of 24.5 kg/m2 were recruited and randomized to the intervention group or control group. The lifestyle intervention was carried out for 3 years by public health nurses using the curriculum and educational materials provided by the study group.


After 1 year, the intervention had significantly improved body weight (-1.5 ± 0.7 vs. -0.7 ± 2.5 kg in the control; p = 0.023) and daily non-exercise leisure time energy expenditure (25 ± 113 vs. -3 ± 98 kcal; p = 0.045). Insulin sensitivity assessed by the Matsuda index was improved by the intervention during the 3 years. The 3-year cumulative incidence tended to be lower in the intervention group (14.8% vs.8.2%, log-rank test: p = 0.097). In a sub-analysis for the subjects with a BMI > 22.5 kg/m2, a significant reduction in the cumulative incidence was found (p = 0.027).


The present lifestyle intervention program using existing healthcare resources is beneficial in preventing diabetes in Japanese with IGT. This has important implications for primary healthcare-based diabetes prevention.

Trial registration number