Utilization of a Metabolic Syndrome Index in Evaluating the Life in Balance Lifestyle Intervention for Prevention of Type 2 Diabetes among Urban American Indians and Alaska Natives
Background: A myriad of diabetes prevention programs modeled on the Diabetes Prevention Program (DPP) are carried out worldwide to fight against the current diabetes pandemic. The percentage of weight reduction is a widely used indicator to evaluate diabetes prevention programs. However, weight change alone may not fully reflect the efficacy of lifestyle intervention. A metabolic syndrome index is a promising novel scale for evaluation of diabetes prevention programs because it is a systematic, comprehensive, and stable indicator that reflects the metabolic risk reduction for diabetes and its complications at multiple levels and dimensions.
Methods: A total of 22 overweight and obese AI/ANs (age, 39.6 ± 10.4 years; BMI, 34.1± 6.3 kg/m2) at increased risk for developing type 2 diabetes residing in Las Vegas participated in the LIB program between April, 2010 and December, 2011. Metabolic syndrome was defined according to the American Heart Association and the National Heart, Lung, and Blood Institute criteria. Clinical measures were collected at three different points in time before and after the completion of the LIB lifestyle core curriculum and the end of post-program follow-up.
Results: Only 12 of the 22 participants completed the whole LIB program. Among the five metabolic syndrome components, only waist circumference demonstrated a significant correlation with weight. After a mean follow-up interval of 10.4 months, the metabolic syndrome index was reduced by 11% at the completion of the LIB program. The study population demonstrated significant decreased waist circumference and elevated HDL cholesterol. Triglycerides manifested the highest percentage change without statistical significance. No significant change was observed in blood pressure and fasting blood glucose.
Conclusions: These findings imply that the application of a metabolic syndrome index provides more detailed information than weight in evaluating diabetes prevention programs by analyzing pre-post changes in multiple diabetes markers, particularly when the target population has normal to slightly elevated BMI. Additionally, the changes in metabolic syndrome components outline the characteristics of diabetes prevention programs, showing great potential for helping public health professionals to individualize and optimize program curriculums for different target populations. Promotion of metabolic syndrome index in diabetes research will establish a unified criterion in evaluating diabetes prevention programs and facilitate efficacy comparison among different programs
