1Dr. Scholl Prevention First GmbH, Prevention First Rüdesheim - Rüdesheim am Rhein - Germany
2Dr. Scholl Prevention First GmbH, Prevention First München - Rüdesheim am Rhein - Germany
A recent Cochrane meta-analysis concluded, that general health check-ups were useless. (1) The data that were used mainly stemmed from the 60s to 80s of the past century, when neither the knowledge nor the means of preventive interventions were comparable to the current possibilities.
We examined the impact of a one-time contemporary health check-up on the risk of progression from pre-diabetes to diabetes.
Between 2001 and 2014, n=1852 men (age 46,0±6,4 years) und n=960 women (age 46,3±5,6 years) participated at least twice in a health check-up offered to them by their respective employer. All participants gave a written consent to the scientific evaluation of the check-up results. Details of the health check-up have been described elsewhere.
Pre-Diabetes was defined according to the ADA Definition (IFG =100 mg/dl and/or HbA1c =5,7-6,4%). A separate analysis was done using only an HbA1c =6,0-6,4% and/or IFG =100 mg/dl.
Patients who fulfilled the criteria for pre-diabetes received a motivational lifestyle coaching including an understandable explanation of the pathophysiology of insulin resistance and its relation to diet, exercise, and diabetes risk. All patients were provided with a individualized exercise prescription (endurance and resistance training) and an individual dietary counselling with the objective to follow a Mediterranean-style low-glycemic-load diet.
744 of 1852 men (40,2%) and 248 of 960 women (25,8%) fulfilled the criteria for pre-diabetes.
Within a follow-up of 3,9 years in men and 3,5 years in women only 2,55% of men and 0,81% of women with pre-diabetes progressed to type 2-diabetes.
This translates into a very low progression rate of 6,5/1000 person-years in men and 2,3/1000 person-years in women. If HbA1c 6,0-6,4% was used instead of 5,7-6,4%, the respective rates were 7,2/1000 in men and 3,8/1000 in women.
A recent meta-analysis of 70 prospective studies reported a much higher progression rate from pre-diabetes to type 2-diabetes of 35/1000 up to 70/1000 person-years depending on the definition used for pre-diabetes.(2)
In this the evaluation of a contemporary health check-up as a one-time intervention with motivational lifestyle coaching we observed an exceptionally low progression rate from pre-diabetes to type 2 diabetes, which clearly demonstrates the effectiveness of this strategy for diabetes prevention.