. 2019 Feb 7;36(3):520–547. doi: 10.1007/s12325-019-0872-8

Table 2.

Dietary strategies employed in landmark studies

Study	Population	Treatment goal	Treatment strategy (interventional group)	Findings
Finnish Diabetes Prevention Study [41, 42]	IGT (2-h plasma glucose 7.8 ± 11.0 mmol/l) BMI > 25 kg/m² (overweight)	To delay development of type 2 diabetes in high-risk individuals with IGT, at least as long as the intervention prevents 5% weight loss or BMI < 25 kg/m² or weight loss of 5–10 kg depending on the degree of obesity	Dietary strategy: Carbohydrates: 50% of daily calories Saturated fats: 10% of daily calories Mono and polyunsaturated fats: 20% of daily calories Cholesterol: < 300 mg/day Dietary fiber to 15 g per 1000 kcal or more Physical activity: 30 min/day or more	Compared with control group 3% reduction in the relative risk of developing type 2 diabetes was observed in the intervention group
Diabetes Prevention Programme [39]	IGT (2-h plasma glucose 140–199 mg/dl based on 75-g OGTT) BMI > 24 kg/m² (> 22 kg/m² among Asian Americans)	To delay development of type 2 diabetes in high-risk individuals with IGT 7% weight loss in first 6 months and maintenance of weight loss throughout the study	Dietary strategy: Individual based (individual model of treatment) Initial phase—to reduce total fat rather than calories, overall healthy eating Later phase—calorie balance: restrict calories and fat To achieve 1–2 lb/week weight loss Physical activity: 150 min/week of moderate physical activity (700 kcal/week expenditure)	Lifetime intervention resulted in 58% reduction in the incidence rate of diabetes
Look AHead Study [55, 151]	Confirmed type 2 diabetes BMI ≥ 25 kg/m² (≥ 27 kg/m² in patients taking insulin)	To achieve and maintain (long term: up to 11.5 years) weight loss in patients with type 2 diabetes to reduce cardiovascular morbidity and mortality 7% weight loss in first year	Dietary strategy: Similar to Finnish Diabetes Prevention study Initial phase—portion control diet containing food with fixed calorie and macronutrient content Later phase—diet modifications depending upon individual weights Physical activity: 175 min/week moderate physical activity	At 1 year, lifetime intervention group lost 8.6% of their initial body weight while the DSE group lost 0.7%. At study end, lifetime intervention group had a 6% weight loss while DSE had 3.5%. With regard to fitness, lifetime intervention had greater improvement in heart rate recovery after graded exercise testing compared with DSE

Study

Population

Treatment goal

Treatment strategy (interventional group)

Findings

Finnish Diabetes Prevention Study [41, 42]

IGT (2-h plasma glucose 7.8 ± 11.0 mmol/l)

BMI > 25 kg/m² (overweight)

To delay development of type 2 diabetes in high-risk individuals with IGT, at least as long as the intervention prevents

5% weight loss or BMI < 25 kg/m² or weight loss of 5–10 kg depending on the degree of obesity

Dietary strategy:

Carbohydrates: 50% of daily calories

Saturated fats: 10% of daily calories

Mono and polyunsaturated fats: 20% of daily calories

Cholesterol: < 300 mg/day

Dietary fiber to 15 g per 1000 kcal or more

Physical activity:

30 min/day or more

Compared with control group 3% reduction in the relative risk of developing type 2 diabetes was observed in the intervention group

Diabetes Prevention Programme [39]

IGT (2-h plasma glucose 140–199 mg/dl based on 75-g OGTT)

BMI > 24 kg/m² (> 22 kg/m² among Asian Americans)

To delay development of type 2 diabetes in high-risk individuals with IGT

7% weight loss in first 6 months and maintenance of weight loss throughout the study

Dietary strategy:

Individual based (individual model of treatment)

Initial phase—to reduce total fat rather than calories, overall healthy eating

Later phase—calorie balance: restrict calories and fat

To achieve 1–2 lb/week weight loss

Physical activity:

150 min/week of moderate physical activity (700 kcal/week expenditure)

Lifetime intervention resulted in 58% reduction in the incidence rate of diabetes

Look AHead Study [55, 151]

Confirmed type 2 diabetes

BMI ≥ 25 kg/m² (≥ 27 kg/m² in patients taking insulin)

To achieve and maintain (long term: up to 11.5 years) weight loss in patients with type 2 diabetes to reduce cardiovascular morbidity and mortality

7% weight loss in first year

Dietary strategy: Similar to Finnish Diabetes Prevention study

Initial phase—portion control diet containing food with fixed calorie and macronutrient content

Later phase—diet modifications depending upon individual weights

Physical activity:

175 min/week moderate physical activity

At 1 year, lifetime intervention group lost 8.6% of their initial body weight while the DSE group lost 0.7%. At study end, lifetime intervention group had a 6% weight loss while DSE had 3.5%. With regard to fitness, lifetime intervention had greater improvement in heart rate recovery after graded exercise testing compared with DSE

BMI body mass index, DSE diabetes support and education, IGT impaired glucose tolerance, OGTT oral glucose tolerance test