• Colin J Greaves, Andrew Middlebrooke, Lucy O'Loughlin, Sandra Holland, Jane Piper, Anna Steele, Tracy Gale, Fenella Hammerton, and Mark Daly.
• Peninsula Medical School, Exeter. Colin.Greaves@pms.ac.uk
• Br J Gen Pract. 2008 Aug 1; 58 (553): 535540535-40.

BackgroundAround 10-15% of adults aged over 40 years have pre-diabetes, which carries a high risk of progression to type 2 diabetes. Intensive lifestyle intervention reduces progression by as much as 58%. However, the cost and personnel requirements of these interventions are major obstacles to delivery in NHS primary care.AimTo assess the effectiveness of a low-cost intervention, delivered in primary care by non-NHS staff, to reduce the risk of diabetes through weight loss and physical activity.Design Of StudyPragmatic single-blind randomised controlled trial with researchers and statistician blinded to group allocation.SettingUK primary care.MethodOne-hundred and forty-one participants with a body mass index of 28 kg/m2 or more, but without diabetes or heart disease, received either information leaflets or individual behavioural counselling using motivational interviewing techniques. The intervention was delivered by five counsellors recruited from the local community. The primary outcomes were the proportions of participants meeting predefined targets for weight loss (5%) and moderate physical activity (150 minutes/week) after 6 months.ResultsUsing intention-to-treat analysis, more people in the intervention group achieved the weight-loss target (24% versus 7% for controls; odds ratio [OR]=3.96; 95% confidence interval [Cl]=1.4 to 11.4; number needed to treat [NNT]=6.1 (95% Cl=4 to 21). The proportion achieving the physical activity target did not increase significantly (38% versus 28% for controls; OR=1.6; 95% Cl=0.7 to 3.8).ConclusionShort-term weight loss, at a level which, if sustained, is clinically meaningful for reducing diabetes risk, is achievable in primary care, without excessive use of NHS monetary or personnel resources.

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