Effects of a lifestyle intervention on cardiovascular risk among high-risk individuals for diabetes in a low- and middle-income setting: Secondary analysis of the Kerala Diabetes Prevention Program

Mojtaba Lotfaliany, Thirunavukkarasu Sathish, Jonathan Shaw, Emma Thomas, Robyn Jennifer Tapp, Nitin Kapoor, Kavumpurathu Raman Thankappan, Brian Oldenburg

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

We aimed to examine whether a lifestyle intervention was effective in reducing cardiovascular disease (CVD) risk in individuals at high-risk of developing diabetes in a low- and middle-income setting. The Kerala Diabetes Prevention Program was evaluated by a cluster-randomized controlled trial (2013-2016) of 1007 individuals (aged 30-60 years) at high-risk for diabetes (Indian Diabetes Risk Score ≥ 60 and without diabetes) in Kerala state, India. Sixty polling areas in Kerala were randomized to intervention or control groups by an independent statistician using a computer-generated randomization sequence. Participants from 30 intervention communities received a 12-month structured peer-support lifestyle intervention program involving 15 group sessions and linked community activities, aimed at supporting and maintaining lifestyle change. The primary outcome for this analysis was the predicted 10-year CVD risk at two years, assessed using the Framingham Risk Score. The mean age at baseline was 46.0 (SD: 7.5) years, and 47.2% were women. Baseline 10-year CVD risk was similar between study groups. The follow-up rate at two years was 95.7%. The absolute risk reduction in predicted 10-year CVD risk between study groups was 0.69% (95% CI: 0.09% to 1.29%, p=0.024) at one year and 0.69% (95% CI: 0.10% to 1.29%, p=0.023) at two years. The favorable change in CVD risk with the intervention condition was mainly due to the reduction in tobacco use (change index: -0.25, 95% CI: -0.42 to -0.09). Our findings suggest that a community-based peer-support lifestyle intervention could reduce CVD risk in individuals at high-risk of developing diabetes in India. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry ACTRN12611000262909.

Original languageEnglish
Article number106068
Pages (from-to)(In-press)
JournalPreventive Medicine
Volume139
Early online date16 Mar 2020
DOIs
Publication statusE-pub ahead of print - 16 Mar 2020
Externally publishedYes

Bibliographical note

Copyright © 2020 Elsevier Inc. All rights reserved.

Keywords

  • Cardiovascular disease
  • Diabetes
  • India
  • Lifestyle
  • Risk prediction

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

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