***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: Background Prevalence of type 2 diabetes ( T2D ) is increasing worldwide . T2D prevention by lifestyle intervention is effective . Pragmatic scalable interventions are needed , with evidence to efficiently target and monitor such interventions . We report pooled analyses of data from three European trial cohorts : to analyse T2D incidence , sustained weight loss and utility of risk predictors . Methods We analysed data on 749 adults with impaired glucose tolerance ( 278 men and 471 women , mean age 56 years , mean BMI 31 kgm−2 ) recruited between 1993 and 2003 , and r and omised to intensive lifestyle intervention ( I ) or lifestyle advice control ( C ) . The intervention aim ed to increase physical activity , modify diet , and promote weight loss≥5 % . Using Cox-regression survival analysis , we assessed T2D incidence and the impact on T2D incidence of sustained weight loss , and of baseline cut-point values of FINDRISC score , fasting plasma glucose ( FPG ) , and HbA1c . Results Mean follow-up duration was 3.1 years . T2D was diagnosed in 139 participants ( I = 45/379 , C = 94/370 ) . Cumulative T2D incidence was 57 % lower in the intervention compared with the control group ( HR 0.42 ( 95 % CI 0.29 to 0.60 ) P<0.001 ) . Participants with ≥5 % weight loss at one year had 65 % lower T2D incidence ( HR 0.35 ( 95 % CI 0.22 to 0.56 ) P<0.001 ) ; maintaining ≥5 % weight loss for two and three years further reduced T2D incidence . Recommended cut-points to identify those at high risk for T2D would have identified different proportions of European Diabetes Prevention Study ( EDIPS ) participants with similar hazard-ratios for intervention effect . Conclusions Pooled analysis of EDIPS trial data reinforces evidence for T2D prevention by lifestyle intervention . Analysis showed the preventive effect of ≥5 % weight loss , especially if maintained long term , which has utility for intervention monitoring . Analysis of proposed cut-points demonstrates difficulties in balancing risk and benefit , to efficiently target interventions and suggests evidence is needed to define clinical policy . Trial registration s The Finnish Diabetes Prevention study , Helsinki , Finl and : Clinical Trials.gov ; NCT00518167 The SLIM diabetes prevention study , Maastricht , The Netherl and s : Clinical Trials.gov ; NCT00381186 The EDIPS-Newcastle diabetes prevention study , Newcastle upon Tyne , UK : International St and ard R and omised Controlled Trial Number ; IS RCT N15670600 We examined self-determination theory ( SDT ) and weight loss , and hypothesized that the Diabetes Prevention Program ’s ( DPP ) intervention would result in an increase in autonomous regulation of motivation ( AR ) in participants . Further , that those with higher AR , and those who perceived educators as supporting SDT-defined needs , would lose more weight . Support , Health Information , Nutrition and Exercise ( SHINE ) Study data ( N = 257 ) were analyzed . SHINE was a r and omized , controlled DPP translation trial ( 2-years , telephonic , primary care staff ) . Autonomous motivation in males increased significantly , while females showed no change . Males with high AR , but not females , lost more weight . However , the significance of these relationships varied over time . Participants who perceived educators as more supportive of psychological needs lost more weight ( especially males ) . However , effect of support on weight loss was not mediated by AR change . Autonomous motivation and educator support are relevant to male weight loss . Future research might develop interventions to enhance autonomous motivation and educator support , and underst and change pathways Background The prevention of  type 2 diabetes  is a recognised health care priority globally . Within the United Kingdom , there is a lack of research investigating optimal methods of translating diabetes prevention programmes , based on the promotion of a healthy lifestyle , into routine primary care . This study aims to establish the behavioural and clinical effectiveness of a structured educational programme design ed to target perceptions and knowledge of diabetes risk and promote a healthily lifestyle , particularly increased walking activity , in a multi-ethnic population at a high risk of developing type 2 diabetes . Design Cluster r and omised controlled trial undertaken at the level of primary care practice s. Follow-up will be conducted at 12 , 24 and 36 months . The primary outcome is change in objective ly measured ambulatory activity . Secondary outcomes include progression to type 2 diabetes , biochemical variables ( including fasting glucose , 2-h glucose , HbA1c and lipids ) , anthropometric variables , quality of life and depression . Methods 10 primary care practice s will be recruited to the study ( 5 intervention , 5 control ) . Within each practice , individuals at high risk of impaired glucose regulation will be identified using an automated version of the Leicester Risk Assessment tool . Individuals scoring within the 90th percentile in each practice will be invited to take part in the study . Practice s will be assigned to either the control group ( advice leaflet ) or the intervention group , in which participants will be invited to attend a 3 hour structured educational programme design ed to promote physical activity and a healthy lifestyle . Participants in the intervention practice s will also be invited to attend annual group-based maintenance workshops and will receive telephone contact halfway between annual sessions . The study will run from 2010–2014 . Discussion This study will provide new evidence surrounding the long-term effectiveness of a diabetes prevention programme run within routine primary care in the United Kingdom . Trial Registration Clinical Trials . Gov identifier : Abstract Background Diabetes prevalence is increasing . The Finnish Diabetes Prevention Study ( DPS ) showed a 58 % reduction in Type 2 Diabetes ( T2D ) incidence in adults with impaired glucose tolerance ( IGT ) . The European Diabetes Prevention Study ( EDIPS ) extends the DPS to different European population s , using the same study design . In the Newcastle arm of this study ( EDIPS-Newcastle ) , we tested the hypothesis that T2D can be prevented by lifestyle intervention and explored secondary outcomes in relation to diabetes incidence . Methods We recruited 102 participants ( 42 men and 60 women , mean age 57 years , mean BMI 34 kgm-2 ) with IGT to EDIPS-Newcastle and r and omised to Intervention and usual care Control groups .  The intervention included individual motivational interviewing aim ed at : weight reduction , increase in physical activity , fibre and carbohydrate intake and reduction of fat intake ( secondary outcomes ) . The primary outcome was diagnosis of T2D . Results Mean duration of follow-up was 3.1 years . T2D was diagnosed in 16 participants ( I = 5 , C = 11 ) . Absolute incidence of T2D was 32.7 per 1000 person-years in the Intervention-group and 67.1 per 1000 person-years in the Control-group . The overall incidence of diabetes was reduced by 55 % in the Intervention-group , compared with the Control-group : RR 0.45 ( 95%CI 0.2 to 1.2).Explanatory survival analysis of secondary outcomes showed that those who sustained beneficial changes for two or more years reduced their risk of developing T2D . Conclusion Our results are consistent with other diabetes prevention trials . This study was design ed as part of a larger study and although the sample size limits statistical significance , the results contribute to the evidence that T2D can be prevented by lifestyle changes in adults with IGT . In explanatory analysis small sustained beneficial changes in weight , physical activity or dietary factors were associated with reduction in T2D incidence . Trial Registration International St and ard R and omised Controlled Trial Number registry ( IS RCT N)Registry number : IS RCT N 15670600 http://www.controlled-trials.com/is rct n/ search .html?srch=15670600%26sort=3%26dir = OBJECTIVE —In participants of the Diabetes Prevention Program ( DPP ) r and omized to intensive lifestyle modification ( ILS ) , meeting ILS goals strongly correlated with prevention of diabetes in the group as a whole . Men met significantly more ILS goals than women but had a similar incidence of diabetes . Therefore , we explored sex differences in risk factors for diabetes and the effect of ILS on risk factors . RESEARCH DESIGN AND METHODS —Baseline risk factors for diabetes and percent change in risk factors over the first year in men versus women were compared using Wilcoxon 's rank-sum tests . RESULTS —At baseline , men were older and had a larger waist circumference ; higher fasting plasma glucose concentration , caloric intake , and blood pressure ; and lower HDL cholesterol and corrected insulin response than women , who were less physically active and had a higher BMI ( P < 0.01 for all comparisons ) . Over the first year of the DPP , no sex difference in risk factors for diabetes was observed for those who lost <3 % body weight . Weight loss of 3–7 % body weight yielded greater decreases in 2-h glucose ( P < 0.01 ) , insulin concentration ( P < 0.04 ) , and insulin resistance ( P < 0.03 ) in men than in women . Weight loss of > 7 % body weight result ed in greater decreases in 2-h glucose ( P < 0.01 ) , triglyceride level ( P < 0.01 ) , and A1C ( P < 0.03 ) in men than in women . CONCLUSIONS —Weight loss > 3 % body weight yielded greater reduction in risk factors for diabetes in men than in women . Despite the more favorable effects of ILS in men , baseline risk factors were more numerous in men and likely obscured any sex difference in incident diabetes Background Mobile technologies for health ( mHealth ) represent a promising strategy for reducing  type 2 diabetes ( T2DM ) risk  . The PROPELS trial investigates whether structured group-based education alone or supplemented with a follow-on support program combining self-monitoring with pedometers and tailored text-messaging is effective in promoting and maintaining physical activity among people at high risk of T2DM . Objective This paper describes the iterative development of the PROPELS follow-on support program and presents evidence on its acceptability and feasibility . Methods We used a modified mHealth development framework with four phases : ( 1 ) conceptualization of the follow-on support program using theory and evidence , ( 2 ) formative research including focus groups ( n=15 , ages 39 - 79 years ) , ( 3 ) pre-testing focus groups using a think aloud protocol  ( n=20 , ages 52 - 78 years ) , and ( 4 ) piloting ( n=11 ) . Analysis was informed by the constant comparative approach , with findings from each phase informing subsequent phases . Results The first three phases informed the structure , nature , and content of the follow-on support program , including the frequency of text messages , the need for tailored content and two-way interaction , the importance of motivational messages based on encouragement and reinforcement of affective benefits ( eg , enjoyment ) with minimal messages about weight and T2DM risk , and the need for appropriate language . The refined program is personalized and tailored to the individual ’s perceived confidence , previous activity levels , and physical activity goals . The pilot phase indicated that the program appeared to fit well with everyday routines and was easy to use by older adults . Conclusions We developed a feasible and innovative text messaging and pedometer program based on evidence and behavior change theory and grounded in the experiences , views , and needs of people at high diabetes risk . A large scale trial is testing the effectiveness of this 4-year program over and above structured group education alone . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 83465245 ; http://www.controlled-trials.com/IS RCT N83465245/83465245 ( Archived by WebCite at http://www.webcitation.org/6dfSmrVAe Background Lifestyle modifications are considered the most effective means of delaying or preventing the development of type 2 diabetes ( T2DM ) . To contain the growing population of T2DM , it is critical to clarify effective and efficient setting s for intervention and modalities for intervention delivery with a wide population reach . The Japan Diabetes Outcome Intervention Trial-1 ( J-DOIT1 ) is a cluster r and omized controlled trial to test whether goal -focused lifestyle coaching delivered by telephone can prevent the development of T2DM in high-risk individuals in a real-world setting . This paper describes the study design and recruitment of the study subjects . Methods For the recruitment of study subjects and their follow-up annually over 3 years , we employed health checkups conducted annually at communities and worksites . Health care divisions recruited from communities and companies across Japan formed groups as a cluster r and omization unit . C and i date s for the study , aged 20 - 65 years with fasting plasma glucose ( FPG ) of 5.6 - 6.9 mmol/l , were recruited from each group using health checkups results in 2006 .  Goal -focused lifestyle support is delivered by healthcare providers via telephone over a one-year period . Study subjects will be followed-up for three years by annual health checkups . Primary outcome is the development of diabetes defined as FPG≥7.0 mmol/l on annual health checkup or based on self-report , which is confirmed by referring to medical cards . Results Forty-three groups ( clusters ) , formed from 17 health care divisions , were r and om 
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AUTHORS ' CONCLUSIONS There is no firm evidence that diet alone or physical activity alone compared to st and ard treatment influences the risk of T2DM and especially its associated complications in people at increased risk of developing T2DM .
However , diet plus physical activity reduces or delays the incidence of T2DM in people with IGT .
Data are lacking for the effect of diet plus physical activity for people with intermediate hyperglycaemia defined by other glycaemic variables .