A Comprehensive Lifestyle Intervention to Prevent Type 2Diabetes and Cardiovascular Diseases: the German CHIP TrialKatharina Wennehorst 1,5 & Klas Mildenstein 2 & Brunhild Saliger 3 & Corinna Tigges 3 &Hans Diehl 4 & Thomas Keil 5,6 & Heike Englert 3Published online: 6 January 2016# Society for Prevention Research 2016Abstract The prevalence of type 2 diabetes is continuouslyincreasing. This chronic metabolic disorder is difficult to treatand imposes a considerable economic burden on thehealthcare system. In view of the fact that type 2 diabetes isprimarily caused by behavioral factors, effective preventivestrategies are urgently needed. We examined the effects of aholisticlifestyleinterventiononclinicalandlaboratoryparam-etersaswellasonthelong-termdiabetesriskinpatientsatriskto develop diabetes. We conducted a randomized controlledtrial in a primary care setting in Hannover, Germany, with 83patients diagnosed as (pre)diabetic or at risk for diabetes.CHIP Germany is a 40-hour coaching lifestyle interventionprogram for the primary and secondary prevention of type 2diabetes and cardiovascular diseases. The intervention includ-ed a comprehensive nutrition and health educational programbased onthe American CHIPapproach. The primary outcomeparameter was the body mass index (BMI). Secondary out-come parameters included body weight, blood pressure,fasting glucose, HbA1c, blood lipids, and the FINDRISKscore, which assesses long-term diabetes risk. At the finalmeasurement after 12 months, in the intervention group theBMI was reduced by 1.4 versus 0.2 kg/m 2 in controls(p=.119). The mean sustained weight loss after 12 monthswas −4.1 kg in the intervention group versus −0.8 kg in con-trols. Furthermore, we found a trend toward a stronger reduc-tion in blood pressure, fasting glucose, and HbA1c as well asan improved FINDRISK score inthe intervention group,com-pared to controls. Although failing to reach statistical signifi-cance at the final assessment, this comprehensive lifestyleintervention showed a noticeable reduction in several cardio-metabolic risk factors which may facilitate the prevention ofdiabetes.Keywords Type2diabetes . Cardiovascularrisk . Lifestylecoaching . Healthbehavior . EmpowermentThe prevalence of type 2 diabetes in Germany is continuouslyincreasing. In 2011, some 4.6 million of German adults(7.2 %) were diagnosed with diabetes (Kurth 2012). Thisemerging epidemic has been accompanied by a marked in-crease in overweight and obesity (Englert et al. 2012).Among German adults, three out of five (60 %) are over-weight, and of these, almost 25 % have been classified asobese (Kurth 2012). Excess weight along with type 2 diabetesare recognized to be associated with hyperlipidemia and car-diovascular diseases (Wilson et al. 2002; AlJaroudi &Petersen 2006; Klein et al. 2004) and have been related tounfavorable dietary habits and an increasingly sedentary life-style (Englert et al. 2012). Compelling evidence has shownthatlifestyle changes and particularlyweight lossare effectivein preventing or delaying the occurrence of type 2 diabetesand in substantially reducing cardiovascular disease risk* Katharina Wennehorstkatharinawennehorst@t-online.de1Department of Internal Medicine, Vinzenzkrankenhaus Hannover,Lange-Feld-Straße 31, 30559 Hannover, Germany2Medical practice Dr. Mildenstein, Gartenstraße 10,30880 Laatzen, Germany3Department of Nutritional Science, University of Applied SciencesMünster, Corrensstraße 25, 48149 Münster, Germany4Lifestyle MedicineInstitute,POB 8/8, LomaLinda,CA92354, USA5Institute for Social Medicine, Epidemiology and Health Economics,Charité - Universitätsmedizin Berlin, Luisenstraße 57,10117 Berlin, Germany6Institute for Clinical Epidemiology and Biometry, University ofWürzburg, Sanderring 2, 97070 Würzburg, GermanyPrev Sci (2016) 17:386–397DOI 10.1007/s11121-015-0623-2
