The impact of social and environmental circumstances on success in an intensive behavioral intervention to lose weight and reduce risk of type 2 diabetes is unknown. We examined the association of social and environmental circumstances such as provisions of social relations and support, home and work environment, and adverse life events on weight loss and diabetes incidence in the Diabetes Prevention Program (DPP) randomized controlled trial.

We included data on 650 female and 319 male adults from the DPP lifestyle intervention group with information on social circumstances and body weight at baseline and follow-up after 6 months (24 weeks of lifestyle intervention), 1, and 2 years. We applied Cox proportional hazards model to obtain hazard ratios (HRs), with social circumstances as the exposures and body weight gain (>7%) or development of diabetes as outcome, adjusting for baseline age, sex, marital status, and number of individuals in the home of the participant.

Life style intervention participants who experienced events or changes at work during the DPP trial had a 44% higher risk of developing diabetes [HRR=1.44, 95% CI:1.02;2.04] as compared to lifestyle intervention participants who did not have such experiences at work. Adjustment of body weight gain after the intervention period explained a small component of this risk: 1.38 [95% CI:0.94;2.03]. Negative changes in the home environment [HRR=1.09, 95% CI:0.76;1.56], low provision of social relations [HRR=1.15, 95% CI:0.81;1.65] or adverse life events [HRR=1.14, 95% CI:0.81;1.62] did not increase the HR of developing diabetes. Social circumstances were not associated with >7% body weight increase between the end of the intervention period and 1 or year 2.

Thus, our results suggest that work changes and stresses may worsen the possibility of lowering diabetes risk through intensive lifestyle interventions.


J. NIelsen: None. M.K. Ali: None.


National Institute of Diabetes and Digestive and Kidney Diseases; General Clinical Research Center; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute on Aging; Office of Research on Women's Health; Office of Research on Minority Health; Centers for Disease Control and Prevention

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