The following is a Centers for Disease Control and Prevention (CDC) statement on a recent article in the New England Journal of Medicine that concluded that "type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects." For the complete report on this Finnish Diabetes Prevention Study, see

Tuomilehto J, Lindstrom J, Eriksson J G, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance*. N Engl J Med 2001 May 3;344(18):1343-50.

1. What were the results of the Finnish Diabetes Prevention Study and what are its implications?

This important study from Finland confirms and extends initial research by demonstrating that sustained changes in lifestyle can substantially reduce the development of type 2 diabetes in middle-aged adults at high risk for diabetes. The lifestyle intervention included better diet, increased physical activity, and modest weight loss. This large, well-designed study involved more than 500 overweight, middle-aged men and women who were at high risk of diabetes because they had higher-than-normal blood sugar levels that were not yet high enough to be diagnosed as diabetes.

After 4 years, the lifestyle intervention group had more than a 50% reduction in diabetes incidence although the average weight loss was low, about 7 pounds or less than 5% of body weight. These compelling results should encourage health care providers, and especially individuals at high risk for diabetes, to make every effort to achieve and maintain a healthy weight and to be physically active. To reduce the burden of diabetes, support from policy makers and health care systems are needed to accomplish these important goals.

2. What is the position of CDC scientists regarding the findings of the Finnish Diabetes Prevention Study? What are the future challenges?

These encouraging data confirm the potential effectiveness of public health programs to encourage healthy lifestyles, especially weight control and increased physical activity, in those individuals at high risk for diabetes. Given the rapid onset and the continuing epidemic of obesity in the United States, and the astonishing 33% increase in diabetes prevalence that occurred in the 1990s, new public health strategies are urgently needed to strengthen and improve ongoing comprehensive diabetes treatment and control programs. These new data from Finland indicate that health care systems should develop and evaluate approaches for primary prevention of diabetes, especially healthy eating, weight control, and increased physical activity.

Challenges that remain include

maintaining a commitment to strengthen preventive care programs for people at risk for diabetes or its complications;
establishing simple, acceptable, and efficient mechanisms to identify those at high risk for developing type 2 diabetes; and
identifying additional resources to add primary prevention strategies as a complementary approach to existing effective diabetes treatment programs.

3. How will the results of the Finnish Diabetes Prevention Study affect the ongoing U.S. Diabetes Prevention Program (DPP)?

The DPP is an ongoing, multicenter study sponsored by the National Institutes of Health (NIH) to determine whether modest lifestyle changes (healthy eating and exercise) or a drug intervention can reduce the development of diabetes in Americans, including people from minority communities, who are at high risk of developing the disease.

Scheduled for completion in 2002, the DPP will answer many important remaining questions about the potential for reducing diabetes incidence in the diverse U.S. population, especially the costs and cost-effectiveness of primary prevention strategies. Given multiple cultural and ethnic differences that are the cornerstone of U.S. society, the impact of weight loss and increased physical activity could vary substantially.

Within the DPP and other ongoing studies of primary prevention among people with impaired glucose tolerance (ITG), pharmacologic interventions might have equal, better, or worse impacts to prevent type 2 diabetes compared to behavioral approaches. Strong clinical and economic data show the effectiveness of existing programs to prevent diabetes complications. Adding new approaches to control diabetes will require commitment and resources from all segments of the health care system.

4. Do the results of the Finnish Diabetes Prevention Study apply to populations in the United States?

The Finnish Diabetes Prevention Study has established a "proof of principle," that is, it is highly likely that in those at high risk to develop type 2 diabetes in the future, modest lifestyle changes can significantly postpone the onset of actual diabetes. The DPP will definitively answer the question of whether results from the Finnish Study apply to the diverse U.S. population with its different culture and society. The DPP and other ongoing trials will also be able to compare drug treatment with behavioral interventions to prevent type 2 diabetes.

For now, perhaps the most important lesson from the Finnish Study is that diabetes may be preventable with modest weight loss and sustained healthful lifestyle changes. In anticipation that the DPP will confirm the Finnish Study results, health agencies should actively consider plans for primary prevention of type 2 diabetes in those at greater risk.

5. How will CDC incorporate the findings of the Finnish Diabetes Prevention Study into intervention programs?

CDC is collaborating with NIH on the DPP to ensure that future research results are translated and implemented broadly and rapidly by the U.S. health care system in order to improve the health of all Americans, especially those at high risk for developing diabetes. With the publication of the Finnish Study, CDC scientists and program experts will intensify their planning.

Current CDC research focuses on defining the burden of diabetes, reducing diabetes complications, and translating science into improved care for people with diabetes, and understanding the needs of special populations. These essentials for people with diabetes must be continued and strengthened, while we identify primary prevention strategies and required additional resources.

6. What are the implications of the Finnish Diabetes Prevention Study for CDC's 59 state and territorial diabetes prevention and control programs (DPCPs) and other local programs?

CDC supports state and territorial DPCPs to focus on community interventions, health communications, and health systems changes to prevent complications and improve the health and quality of life for all people with diabetes. DPCP s and their partners help translate the best prevention science into practice to prevent the devastating complications of diabetes, including blindness, amputations, kidney disease, and heart disease. Diabetes is now the sixth leading cause of death. With the recent epidemic increases in obesity, ensuring that all people with diabetes benefit from what we already know is an enormous challenge.

The findings of the Finnish Study apply only to specific populations at high risk for developing diabetes and not to the total population. Based on these findings, DPCP s should consider the following:

educate and establish dialogues with policy-makers about the opportunities in primary prevention, and request resources to advance programs, if possible.
use the Finnish Study as a basis and rationale to form, expand, or solidify links with new and existing partners.
begin to actively engage stakeholders in planning for primary prevention of type 2 diabetes for those at greatest risk, in anticipation that the DPP, a study that is very relevant to the U.S. population and society, will confirm results of the Finnish Study.

7. Who is at "high risk" to develop type 2 diabetes?

Based on the Finnish Diabetes Prevention Study, those who are overweight, middle-aged, and with blood sugars above normal, but not yet at the diabetes level (that is, those with impaired glucose tolerance or IGT) are at higher risk to develop diabetes in the future. These are also the individuals who benefitted from the three behavioral interventions—improved diet, modest weight loss, and increased physical activity. It is likely that these same "high-risk characteristics" would apply to Americans.

8. How should people with IGT be identified? How many Americans are in this category?

We do not yet know the best strategy to identify people who might benefit from primary prevention. Present information suggests that some measurement of blood sugar will be required (for more details, see another CDC statement on screening for undiagnosed diabetes).

However, there is no consensus on the appropriate conditions for testing or diagnostic values. Previous studies suggest there may be as many as 20 million people in the United States with IGT. A substantial number of these people have health characteristics similar to those who were studied in Finland.

Identifying high-risk individuals and effectively implementing primary prevention strategies will require further substantial planning and resources.

9. How efficient is this type of lifestyle intervention?

Based on the Finnish Study findings, these lifestyle interventions look promising. One method to determine the efficiency of interventions is to examine the number of people that programs would have to treat over a 5-year period in order to prevent a case of type 2 diabetes. The Finnish Diabetes Prevention Study observed that treating 5 people over 5 years would prevent 1 case of diabetes. This compares favorably to other interventions with a "number-needed-to-treat" of less than 100 to prevent one case. The Finnish Study results indicate that the intervention is very "efficient" and thus deserves serious consideration.

* Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.

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