A Comprehensive Lifestyle Intervention to Prevent Type 2 Diabetes and Cardiovascular Diseases: the German CHIP Trial
The prevalence of type 2 diabetes is continuously increasing. This chronic metabolic disorder is difficult to treat and imposes a considerable economic burden on the healthcare system. In view of the fact that type 2 diabetes is primarily caused by behavioral factors, effective preventive strategies are urgently needed. We examined the effects of a holistic lifestyle intervention on clinical and laboratory parameters as well as on the long-term diabetes risk in patients at risk to develop diabetes. We conducted a randomized controlled trial in a primary care setting in Hannover, Germany, with 83 patients diagnosed as (pre)diabetic or at risk for diabetes. CHIP Germany is a 40-hour coaching lifestyle intervention program for the primary and secondary prevention of type 2 diabetes and cardiovascular diseases. The intervention included a comprehensive nutrition and health educational program based on the American CHIP approach. The primary outcome parameter was the body mass index (BMI). Secondary outcome parameters included body weight, blood pressure, fasting glucose, HbA1c, blood lipids, and the FINDRISK score, which assesses long-term diabetes risk. At the final measurement after 12 months, in the intervention group the BMI was reduced by 1.4 versus 0.2 kg/m2 in controls (p = .119). The mean sustained weight loss after 12 months was −4.1 kg in the intervention group versus −0.8 kg in controls. Furthermore, we found a trend toward a stronger reduction in blood pressure, fasting glucose, and HbA1c as well as an improved FINDRISK score in the intervention group, compared to controls. Although failing to reach statistical significance at the final assessment, this comprehensive lifestyle intervention showed a noticeable reduction in several cardiometabolic risk factors which may facilitate the prevention of diabetes.
KeywordsType 2 diabetes Cardiovascular risk Lifestyle coaching Health behavior Empowerment
The authors are indebted to the DAK Deutsche Angestellten-Krankenkasse Hannover, Germany, for recruitment of study participants, making available their training classrooms, and refunding the intervention program’s admission fee. The authors are also grateful to the reviewers for thoughtful comments on the manuscript and to Dr. Wolfgang Reimers for participation in the first statistical analyses. They also wish to thank Bengt Wennehorst for assistance in the final statistical analyses and Karel Vermeulen for helping with the implementation of the permutation based Augmented Mann-Whitney U test.
Compliance with Ethical Standards
This study was funded by a grant to Heike Englert from the German Diabetes Foundation (DDS) (grant number: 185/03/0).
Conflict of interest
Hans Diehl invented the Complete Health Improvement Program (CHIP; formerly Coronary Health Improvement Project); he was the director and is currently the consultant of the Lifestyle Medicine Institute, LLC (Loma Linda, CA, USA), which promotes the Complete Health Improvement Program. Klas Mildenstein developed the “ChipListe” food nutrition table utilized in the German CHIP program. Heike Englert was principle investigator of the German CHIP trial. Katharina Wennehorst, Brunhild Saliger, Corinna Tigges and Thomas Keil declared no conflict of interest.
Prior to initiating this research, the study protocol was reviewed by, and approval was obtained from, the ethical review committee Campus Charité Mitte (CCM) of the Charité-Universitätsmedizin Berlin, Germany. All procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Participants granted written consent prior to participation in this study.
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