Differential physical activity responses to diabetes risk reduction interventions according to prediabetes phenotype in at-risk individuals: pooled analysis from three randomised controlled trials

Q: What are the key findings of this study?

Structured group-based lifestyle interventions increased ambulatory activity in individuals with IGT (+523 steps/day) and IFG+IGT (+808 steps/day), but not in isolated IFG (+71 steps/day, p=0.781).

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: At risk of type 2 diabetes (prediabetes phenotypes: IFG, IGT, IFG+IGT, or normoglycaemia) (n=2150). Intervention: Structured group-based lifestyle intervention (Walking Away, Walking Away Plus, Let's Prevent Diabetes) vs. Usual care plus a standardised information booklet on type 2 diabetes risk and prevention. Primary outcome: Ambulatory activity (steps/day) over 48 months in the combined IFG and IGT subgroup (MD 808 steps/day, 95% CI 402, 1213, p=<0.001).

Q: What does this research mean for the field?

Physical activity responses to structured diabetes prevention lifestyle interventions differ by glycemic phenotype, increasing ambulatory activity in individuals with impaired glucose tolerance but producing no significant increase in those with isolated impaired fasting glucose. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether physical activity and glycemic responses to diabetes risk reduction lifestyle interventions differ across prediabetes phenotypes.

Emily James; Joseph Henson; Melanie J. Davies; Kamlesh Khunti; Thomas Yates

doi:10.1007/s00125-026-06873-5

September 14, 2026DiabetologiaOpen Access

Differential physical activity responses to diabetes risk reduction interventions according to prediabetes phenotype in at-risk individuals: pooled analysis from three randomised controlled trials

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Key result

Lifestyle interventions boost physical activity by ~808 steps/day in combined IFG/IGT, but fail in isolated IFG.

MD +808 steps/day
95% CI 402, 1213
P<0.001
n=2,150

Why the study?

The effects of lifestyle interventions to reduce type 2 diabetes risk may differ by prediabetes phenotype, but whether physical activity responses vary accordingly was unclear.

Does a structured group-based lifestyle and physical activity intervention differentially increase ambulatory activity (steps/day) and improve glycaemia across distinct prediabetes phenotypes (normoglycaemia, isolated IFG, isolated IGT, and combined IFG+IGT) in adults at high risk of type 2 diabetes?

Key Points

To determine whether physical activity and glycemic responses to diabetes risk reduction lifestyle interventions differ across prediabetes phenotypes.
Pooled analysis of three randomized controlled trials (Let’s Prevent Diabetes, PROPELS, Walking Away; n=2150) with up to 48 months of annual follow-up.
Participants at risk of type 2 diabetes were randomized to usual care or structured group-based lifestyle interventions promoting physical activity through education, goal setting, and pedometers.
Outcomes were stratified by baseline glycemic status: normoglycaemia, isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), or combined IFG and IGT.
Relative to usual care over 48 months, daily ambulatory activity increased by 247 steps/day (95% CI 4, 491; p=0.047) in normoglycaemia, 523 steps/day (95% CI 229, 818; p<0.001) in isolated IGT, and 808 steps/day (95% CI 402, 1213; p<0.001) in IFG+IGT, but did not increase in isolated IFG (71 steps/day; 95% CI −429, 571; p=0.781).
The intervention reduced 2 h post-challenge glucose levels only in the combined IFG+IGT group (mean −0.5 mmol/l; 95% CI −0.9, −0.0; p=0.039), with no significant effect in isolated IFG (0.0 mmol/l; p=0.857) or isolated IGT (0.1 mmol/l; p=0.477).
Fasting glucose did not significantly differ between intervention and usual care across any glycemic phenotype over 48 months (all p≥0.363).

Study Design

Type

Meta-Analysis (n=2,150)

Randomization

Cluster randomization at the general practitioner (GP) practice level (1:1 in Walking Away and Let's Prevent Diabetes; 1:1:1 in PROPELS)

Multicenter

Yes

Structured PICO

Does a structured group-based lifestyle and physical activity intervention differentially increase ambulatory activity (steps/day) and improve glycaemia across distinct prediabetes phenotypes (normoglycaemia, isolated IFG, isolated IGT, and combined IFG+IGT) in adults at high risk of type 2 diabetes?

P

Population

2,150 adults in the United Kingdom at high risk of type 2 diabetes across three pooled cluster RCTs, stratified by baseline glycaemic status (normoglycaemia, isolated IFG, isolated IGT, and combined IFG+IGT), followed for up to 48 months.

I

Intervention

Structured group-based behavioural lifestyle interventions (Walking Away, Walking Away Plus, and Let's Prevent Diabetes) based on the PREPARE programme (up to 10 participants per group). Comprised a 3 h or 6 h initial structured education session, self-regulation with pedometer provision and personalised goal setting (typically aiming to increase by 3000 steps/day via proximal goals of +500 steps/day every 2 weeks), 2 h or 3 h follow-on group refresher sessions at 12 and 24 months, and 15 min telephone calls (every 3 months or at 6, 18, and 30 months; plus bespoke text-messaging in Walking Away Plus).

C

Comparator

Usual care (control) plus a standardised information booklet on type 2 diabetes risk and prevention based on Leventhal's common-sense model covering five domains (causes, consequences, identity, control/treatment, and timeline).

O

Outcome

Change in ambulatory activity (steps/day), objectively measured over 7 consecutive days via hip/trunk-worn sealed piezoelectric pedometers (NL-800) or accelerometers (ActiGraph GT3X), assessed over up to 48 months (at 12, 24, 36, and 48 months follow-up).surrogate

Main Result

Mean Difference: 808 (95% CI 402–1213)

Absolute Event Rate: 6229% vs 5409%

p-value: p=<0.001

Limitations

Pooling of three large datasets with some methodological differences between interventions (such as follow-up timepoints and duration of the core group-based education session: 6 h vs 3 h).
Post hoc analysis of studies that were not originally designed to address this specific research question.
Pooling of three large datasets with methodological differences between interventions, including follow-up timepoints and duration of the core group-based education session (6 h in Let's Prevent Diabetes vs 3 h in Walking Away and PROPELS).
Post hoc analysis of randomised controlled trials that were not originally designed to address this research question.

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Implication

Structured group-based lifestyle interventions elicit clinically meaningful increases in physical activity in individuals with IGT (with or without IFG) but not in those with isolated IFG, suggesting that differential behavioural responses may underlie phenotype-specific differences in diabetes prevention efficacy.

Abstract

Aims/hypothesis Emerging research suggests that the effects of lifestyle interventions to reduce the risk of type 2 diabetes progression differ by prediabetes phenotype. We investigated whether this divergent effectiveness is accompanied by differing physical activity responses to the intervention. Methods Pooled data from three randomised controlled trials were used ( n =2150), with up to 48 months annual follow-up. Participants at risk of type 2 diabetes were randomised to either: (1) usual care (control) or (2) similar interventions, in which they received structured group-based lifestyle interventions to promote increases in physical activity and other behaviours associated with diabetes risk reduction, supported by education, goal setting, pedometer use and maintenance support. Change in physical activity and glucose levels were stratified by the presence of impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). Results Participants in the group with normoglycaemia were 63 years old (mean), with a mean BMI of 29.9 kg/m 2 ; 56.4% were men and 76.7% were White European. Participants in the IFG group were 63 years old, with a BMI of 29.8 kg/m 2 ; 70.0% were men and 79.1% were White European. Participants in the IGT group were 65 years old, with a BMI of 31.1 kg/m 2 ; 60.4% were men and 80.5% were White European. Participants in the group with both IFG and IGT were 65 years old, with a BMI of 31.7 kg/m 2 ; 62.7% were men and 82.6% were White European. The number of baseline steps/day was 6130 ± 3201 in the normoglycaemia group, 7244 ± 3489 in the IFG group, 5984 ± 2904 in the IGT group and 6310 ± 2872 in the IFG+IGT group (means ± SD). The intervention increased the mean number of steps/day relative to usual care by 247 (95% CI 4, 491) in the normoglycaemia group, 523 (95% CI 229, 818) in the IGT group, and 808 (95% CI 402, 1213) in the IFG+IGT group, but not in the IFG group (mean 71; 95% CI −429, 571). The intervention improved 2 h post-challenge glucose levels in the IFG+IGT group only (mean −0.5 mmol/l; 95% CI −0.9, 0.0). Conclusions/interpretation The effectiveness of structured, group-based interventions with goal setting to promote physical activity differs by glycaemic status; those with IFG were least responsive. This may contribute to previously observed differences in the clinical effectiveness of diabetes prevention programmes.

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Cite This Study

James et al. (2026) conducted a meta-analysis in At risk of type 2 diabetes (prediabetes phenotypes: IFG, IGT, IFG+IGT, or normoglycaemia) (n=2,150). Structured group-based lifestyle intervention (Walking Away, Walking Away Plus, Let's Prevent Diabetes) vs. Usual care plus a standardised information booklet on type 2 diabetes risk and prevention was evaluated on Ambulatory activity (steps/day) over 48 months in the combined IFG and IGT subgroup (MD 808 steps/day, 95% CI 402, 1213, p=<0.001). Structured group-based lifestyle interventions increased ambulatory activity in individuals with IGT (+523 steps/day) and IFG+IGT (+808 steps/day), but not in isolated IFG (+71 steps/day, p=0.781).

synapsesocial.com/papers/6aa913a29013453be30a1b78 https://doi.org/10.1007/s00125-026-06873-5

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Differential physical activity responses to diabetes risk reduction interventions according to prediabetes phenotype in at-risk individuals: pooled analysis from three randomised controlled trials

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Differential physical activity responses to diabetes risk reduction interventions according to prediabetes phenotype in at-risk individuals: pooled analysis from three randomised controlled trials

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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