***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Changing dietary and physical activity habits has the potential to postpone or prevent the development of type 2 diabetes . However , it needs to be assessed whether moderate interventions , in agreement with current guidelines for the general population , are effective . We evaluated the impact of a 2-year combined diet and physical activity intervention program on glucose tolerance in Dutch subjects at increased risk for developing diabetes . RESEARCH METHODS AND PROCEDURES Subjects with glucose intolerance were r and omly assigned to either the lifestyle intervention group ( INT ) or control group ( CON ) . The INT received regular dietary advice and was stimulated to increase their physical activity . The CON received a brief leaflet about healthy diet and increased physical activity . Primary outcome measure was the change in glucose tolerance . RESULTS In total , 88 subjects completed 2 years of intervention ( 40 subjects in the INT , 48 subjects in the CON , mean BMI 29.4 kg/m2 ) . Subjects in the INT reduced their body weight , waist circumference , and ( saturated ) fat intake and improved their aerobic capacity . Two-hour plasma glucose concentration declined from 8.7 to 8.0 mM in the INT and rose from 8.6 to 9.4 mM in the CON ( p < 0.01 ) . Subjects adherent to both the diet and exercise intervention showed the largest reduction in 2-hour glucose levels . DISCUSSION Our results showed that a lifestyle intervention program according to general recommendations improves glucose tolerance , even in a less obese and more physical active population . Furthermore , our results underscore the importance of combining diet and physical activity to improve glucose tolerance and insulin resistance Lifestyle modification reduces the risk of developing type 2 diabetes and may have its effect through improving insulin sensitivity , beta-cell function , or both . To determine whether diet and exercise improve insulin sensitivity and /or beta-cell function and to evaluate these effects over time , we quantified insulin sensitivity and the acute insulin response to glucose ( AIRg ) in 62 Japanese Americans ( age 56.5 + /- 1.3 years ; mean + /- SE ) with impaired glucose tolerance ( IGT ) who were r and omized to the American Heart Association ( AHA ) Step 2 diet plus endurance exercise ( n = 30 ) versus the AHA Step 1 diet plus stretching  ( n = 32 ) for 24 months . beta-Cell function ( disposition index [ DI ] ) was calculated as S(i ) x AIRg , where S(i ) is the insulin sensitivity index . The incremental area under the curve for glucose ( incAUCg ) was calculated from a 75-g oral glucose tolerance test . Intra-abdominal fat ( IAF ) and subcutaneous fat ( SCF ) areas were measured by computed tomography . At 24 months , the Step 2/endurance group had lower weight ( 63.1 + /- 2.4 vs. 71.3 + /- 2.9 kg ; P = 0.004 ) and IAF ( 75.0 + /- 7.9 vs. 112.7 + /- 10.4 cm(2 ) ; P = 0.03 ) and SCF ( 196.5 + /- 18.0 vs. 227.7 + /- 19.9 cm(2 ) ; P < 0.001 ) areas , greater S(i ) ( 4.7 + /- 0.5 vs. 3.3 + /- 0.3 x 10(-5 ) min . pmol(-1 ) . l(-1 ) ; P = 0.01 ) , and a trend toward lower AIRg ( 294.9 + /- 50.0 vs. 305.4 + /- 30.0 pmol/l ; P = 0.06 ) and incAUCg ( 8,217.3 + /- 350.7 vs. 8,902.0 + /- 367.2 mg . dl(-1 ) . 2 h(-1 ) ; P = 0.08 ) compared with the Step 1/stretching group after adjusting for baseline values . There was no difference in the DI ( P = 0.7 ) between the groups . S(i ) was associated with changes in weight ( r = -0.426 , P = 0.001 ) and IAF ( r = -0.395 , P = 0.003 ) and SCF ( r = -0.341 , P = 0.01 ) areas . Thus , the lifestyle modifications decreased weight and central adiposity and improved insulin sensitivity in Japanese Americans with IGT . However , such changes did not improve beta-cell function , suggesting that this degree of lifestyle modifications may be limited in preventing type 2 diabetes over the long term AIMS To evaluate the efficacy of interventions to promote a healthy diet and physical activity in people with impaired glucose tolerance ( IGT ) . METHODS A r and omised controlled trial in Newcastle upon Tyne , UK , 1995 - 98 . Participants included 67 adults ( 38 men ; 29 women ) aged 24 - 75 years with IGT . The intervention consisted of regular diet and physical activity counselling based on the stages of change model . Main outcome measures were changes between baseline and 6 months in nutrient intake ; physical activity ; anthropometric and physiological measurements including serum lipids ; glucose tolerance ; insulin sensitivity . RESULTS The difference in change in total fat consumption was significant between intervention and control groups ( difference -21.8 ( 95 % confidence interval ( CI ) -37.8 to -5.8 ) g/day , P=0.008 ) . A significantly larger proportion of intervention participants reported taking up vigorous activity than controls ( difference 30.1 , ( 95 % CI 4.3 - -52.7)% , P=0.021 ) . The change in body mass index was significantly different between groups ( difference -0.95 ( 95 % CI -1.5 to -0.4 ) kg/m(2 ) , P=0.001 ) . There was no significant difference in change in mean 2-h plasma glucose between groups ( difference -0.19 ( 95 % CI -1.1 to 0.71 ) mmol/l , NS ) or in serum cholesterol ( difference 0.02 ( 95 % CI -0.26 to 0.31 ) mmol/l , NS ) . The difference in change in fasting serum insulin between groups was significant ( difference -3.4 ( 95 % CI -5.8 to -1.1 ) mU/l , P=0.005 ) . CONCLUSIONS After 6 months of intensive lifestyle intervention  in participants with IGT , there were changes in diet and physical activity , some cardiovascular risk factors and insulin sensitivity , but not glucose tolerance . Further follow-up is in progress to investigate whether these changes are sustained or augmented over 2 years Prevention of type 2 diabetes by intensive lifestyle intervention design ed to achieve and maintain ideal body weight was assessed in subjects with impaired glucose tolerance ( IGT ) . Male subjects with IGT recruited from health-screening examinees were r and omly assigned in a 4:1 ratio to a st and ard intervention group ( control group ) and intensive intervention group ( intervention group ) . The final numbers of subjects were 356 and 102 , respectively . The subjects in the control group and in the intervention group were advised to maintain body mass index ( BMI ) of < 24.0 kg/m2 and of < 22.0 kg/m2 , respectively , by diet and exercise . In the intervention group , detailed instructions on lifestyle were repeated every 3 - 4 months during hospital visits . Diabetes was judged to have developed when two or more consecutive fasting plasma glucose ( FPG ) values exceeded 140 mg/dl . A 100 g oral glucose tolerance test was performed every 6 months to detect improvement of glucose tolerance . The subjects were seen in an ordinary outpatient clinic . The cumulative 4-year incidence of diabetes was 9.3 % in the control group , versus 3.0 % in the intervention group , and the reduction in risk of diabetes was 67.4 % ( P < 0.001 ) . Body weight decreased by 0.39 kg in the control group and by 2.18 kg in the intervention group ( P < 0.001 ) . The control group was subclassified according to increase and decrease in body weight . The incidence of diabetes was positively correlated with the changes in body weight , and the improvement in glucose tolerance was negatively correlated . Subjects with higher FPG at baseline developed diabetes at a higher rate than those with lower FPG . Higher 2h plasma glucose values and higher BMI values at baseline were also associated with a higher incidence of diabetes , but the differences were not significant . Subjects with a low insulinogenic index ( DeltaIRI/DeltaPG 30 min after an oral glucose load ) developed diabetes at a significantly higher rate than those with a normal insulinogenic index . Comparison of the BMI data and incidence of diabetes in five diabetes prevention studies by lifestyle intervention revealed a linear correlation between the incidence of diabetes and the BMI values , with the exception of the DaQing Study . However , the slope of the reduction in incidence of diabetes in the intensive intervention groups was steeper than expected simply on the basis of the reduction of BMI , suggesting that the effect of lifestyle intervention can not be solely ascribed to the body weight reduction . We conclude that lifestyle intervention aim ed at achieving ideal body weight in men with IGT  is effective and can be conducted in an outpatient clinic setting OBJECTIVE The Diabetes Prevention Program demonstrated the ability to delay or prevent type 2 diabetes in participants with impaired glucose tolerance ( IGT ) . Participants with IGT are at high risk for cardiovascular disease ( CVD ) , with a marked increase in the number and severity of CVD risk factors . We prospect ively assessed the impact of our interventions on hypertension , dyslipidemia , and CVD events . RESEARCH DESIGN AND METHODS The study group consisted of 3,234 individuals with IGT r and omly assigned to receive intensive lifestyle intervention , metformin , or placebo . Annual assessment of blood pressure , lipids , electrocardiogram , and CVD events was undertaken . RESULTS Hypertension was present in 30 % of participants at study entry and then increased in the placebo and metformin groups , although it significantly decreased with intensive lifestyle intervention . Triglyceride levels fell in all treatment groups , but fell significantly more with intensive lifestyle intervention . Total cholesterol and LDL cholesterol levels were similar among treatment groups . Intensive lifestyle intervention significantly increased the HDL cholesterol level and reduced the cumulative incidence of the proatherogenic LDL phenotype B. At 3 years of follow-up , the use for pharmacologic therapy to achieve established goals in the intensive lifestyle group was 27 - 28 % less for hypertension and 25 % less for hyperlipidemia compared with placebo and metformin groups . Over an average of 3 years , 89 CVD events from 64 participants were positively adjudicated study wide , with no differences among treatment groups . CONCLUSIONS Lifestyle intervention improves CVD risk factor status compared with placebo and metformin therapy . Although no differences in CVD events were noted after 3 years , achieved risk factor modifications suggest that longer intervention may reduce CVD event rates Aims /hypothesis . The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  Type II ( non-insulin-dependent ) diabetes mellitus in subjects with impaired glucose tolerance , to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance . Methods . A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were r and omised to either a control or intervention group . The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits . The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aim ed at reducing weight , the intake of saturated fat and increasing the intake of dietary fibre . Intervention subjects were also guided individually to increase their physical activity .  Results . During the first year , weight loss in the first 212 study subjects was 4.7 ± 5.5 vs 0.9 ± 4.1 kg in the intervention and control group , respectively ( p < 0.001 ) . The plasma glucose concentrations ( fasting : 5.9 ± 0.7 vs 6.4 ± 0.8 mmol/l , p < 0.001 ; and 2-h 7.8 ± 1.8 vs 8.5 ± 2.3 mmol/l , p < 0.05 ) were significantly lower in the intervention group after the first year of intervention . Favourable changes were also found in blood pressure , serum lipids and anthropometric indices in the intervention group . Conclusion /interpretation . The interim results show the efficacy and feasibility of the lifestyle intervention programme . [ Diabetologia ( 1999 ) 42 : 793–801 Context Weight loss and exercise decrease the development of diabetes in people with impaired glucose tolerance , but the effectiveness of these interventions in people with normal glucose tolerance is unknown . Contribution Using 
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This had also favourable effects on weight and body mass index reduction , waist-to-hip ratio and waist circumference .
However , statistical heterogeneity was very high for these outcomes .
Exercise and diet interventions had a very modest effect on blood lipids .
AUTHORS ' CONCLUSIONS Interventions aim ed at increasing exercise combined with diet are able to decrease the incidence of type 2 diabetes mellitus in high risk groups ( people with impaired glucose tolerance or the metabolic syndrome ) .