273-OR: Comparative Effectiveness of Lifestyle Intervention on Fasting Plasma Glucose in Normal Weight vs. Overweight/Obese Adults with Prediabetes

Abstract

Almost 1 in 5 U.S. adults with prediabetes have a normal BMI. It is hypothesized that such individuals develop diabetes through different pathophysiological mechanisms and that methods of prevention may differ in the absence of overweight/obesity. Normal BMI is an exclusion criterion for many diabetes prevention programs and scarce data are available on the effectiveness of lifestyle intervention in normal weight adults with prediabetes. In this study, we compared the effect of technology-enabled lifestyle health coaching (LHC) on fasting plasma glucose (FPG) in normal weight (BMI 18.5-24.9 kg/m²; n = 188), overweight (BMI 25.0-29.9 kg/m²; n = 495) and obese (BMI >30.0 kg/m²; n = 1,214) adults with prediabetes. Subjects were 1,897 consecutive adults with prediabetes (FPG = 100-125 mg/dl and not taking antidiabetic medication) who completed a baseline and follow-up evaluation as part of an LHC program (mean follow-up = 145 days). LHC included 1-on-1 behaviorally-oriented coaching, predominantly via the telephone and Internet, on exercise, nutrition and weight management. BMI decreased significantly (p <0.001) in the overweight (-0.6±1.1 kg/m²) and obese (-1.3±1.8 kg/m²) participants but was unchanged (0.0±1.5 kg/m²) in the normal weight participants. In contrast, weekly aerobic exercise increased (normal weight = 77±167 min/week increase; overweight = 98±191 min/week increase; and obese = 95±146 min/week increase) and FPG decreased (normal weight = -9±9 mg/dl decrease; overweight = -7±9 mg/dl decrease; and obese = -6±10 mg/dl decrease) significantly (p <0.001) in all 3 groups (p <0.05 for magnitude of decrease in FPG in normal weight versus obese participants). FPG was reduced to <100 mg/dl in 62.4%, 51.7% and 43.6% of the normal weight, overweight and obese participants, respectively. These data suggest that LHC is at least as effective in managing FPG in normal weight adults with prediabetes versus those who are overweight/obese.