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Lifestyle interventions in persons with impaired glucose tolerance (IGT) delay the onset of diabetes, but freedom from complications is a major goal of diabetes prevention and management. The extent that lifestyle intervention can delay the onset of the common but serious complications of diabetes is ill-defined. We assessed freedom from any serious diabetes-related complication in the 30-year follow-up data from the Da Qing Diabetes Prevention study in which 576 adults with IGT, randomized to control or lifestyle intervention groups for six-years, were followed from the time of randomization to determine the onset of diabetes and occurrence of any serious diabetes-related complication defined as CVD events or death, severe retinopathy, nephropathy, neuropathy, or death due to acute diabetes complications or infection. We estimated differences between the intervention and control groups in the incidence and time free of serious complications. Lifestyle interventions significantly increased the time free of major serious diabetes-related complications (Table). The study provides yet further evidence supporting the value of implementing lifestyle interventions in persons with IGT. Disclosure Q. Gong: None. P. Zhang: None. J. Wang: None. Y. Chen: None. Y. An: None. X. Feng: None. Y.J. Cheng: None. J. Ma: None. P.H. Bennett: Advisory Panel; Self; World Health Organization. Stock/Shareholder; Self; Eli Lilly and Company, Pfizer Inc., Unilever, UnitedHealth Group. Other Relationship; Self; American Diabetes Association, European Association for the Study of Diabetes, European Diabetic Nephropathy Study Group, International Diabetes Federation, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. G. Li: None.

Despite its growing prevalence in China, the extent to which diabetes leads to excess mortality and its underlying causes are ill-defined. Six-hundred and six persons with newly diagnosed diabetes (NDD) and a comparison group of 494 with normal glucose tolerance (NGT) were identified in 1986 by screening 110,660 adults aged 25-74 years who agreed to participate in The Da Qing IGT and Diabetes study. A follow-up study of the original study participants was conducted in 2016. We compared death rates and causes of death between the two groups during 30 years of follow-up. Four-hundred and forty (71.7%) participants with NDD and 153 (31.0%) with NGT died. Overall mortality (rates/1,000 person-years + 95% CI) were much higher in those with NDD than with NGT, 40.8 (35.6-46.5) vs.15.8 (13.0-19.1) in men (P< 0.0001), and 30.4 (26.4-34.9) vs. 6.9 (5.0-9.3) in women (P In conclusion, diabetes is associated with substantially increased risks of death in Chinese adults, especially from CVD, renal failure, infection and cancer. Earlier age at diagnosis leads to greater relative risk of death. Disclosure Y. An: None. P. Zhang: None. J. Wang: None. Q. Gong: None. B. Zhang: None. Y. Chen: None. E. Gregg: None. P.H. Bennett: Consultant; Self; World Health Organization. Stock/Shareholder; Self; Becton, Dickinson and Company, Eli Lilly and Company, Pfizer Inc., UnitedHealth Group Inc. Other Relationship; Self; American Diabetes Association, Centers for Disease Control and Prevention, European Association for the Study of Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. G. Li: None. Funding Centers for Disease Control and Prevention/Chinese Center for Disease Control and Prevention (5U19GH000636-05)

Responses to lifestyle interventions in people with impaired glucose tolerance (IGT) may differ during the intervention phase: some progress to diabetes, some regress to normal glucose tolerance (NGT) and some retain IGT. Whether these different responses to intervention influence subsequent outcomes is uncertain. In 1986, 576 persons with IGT in Da Qing, China, were randomized to control or intervention (diet, exercise, diet plus exercise) groups for a six-year lifestyle intervention. In 1992, of 540 participants who completed the intervention, 252 (46.7%) had progressed to diabetes, 174 (32.2%) regressed to NGT, and 114 (21.1%) remained as having IGT. In 2016, we conducted a 30-year follow-up study to assess the intervention effect on CVD events, defined as the first occurrence of non-fatal or fatal stroke, myocardial infarction or heart failure, and composite microvascular complications, defined as the first occurrence of severe retinopathy, nephropathy or neuropathy. We compared the difference in those outcomes between the three groups. The 30-year cumulative incidence of CVD was 65.6% (95% CI 58.7-71.5) in the participants with diabetes, 46.1% (95% CI 48.0-53.8) in those with NGT, and 50.6% (95% CI 40.5-59.9) in those with IGT. The corresponding incidence of microvascular complications was 44.3% (95% CI 36.8-51.4), 23.1%, (95% CI 15.7-31.4), and 31.2% (95% CI 21.1-41.7). Adjusting for age and sex, those who had developed diabetes had significantly higher risks than those who had reverted to NGT for both CVD (HR = 1.57, 95% CI 1.18-2.07, P = 0.002) and composite microvascular complications (HR = 2.53, 95% CI 1.62-3.93, P < 0.0001). Our results indicate that delaying the development of diabetes in people with IGT is likely to reduce the incidence of both macro and microvascular adverse outcomes. Disclosure Y. Chen: None. P. Zhang: None. J. Wang: None. Q. Gong: None. Y. An: None. E. Gregg: None. P.H. Bennett: Consultant; Self; World Health Organization. Stock/Shareholder; Self; Becton, Dickinson and Company, Eli Lilly and Company, Pfizer Inc., UnitedHealth Group Inc. Other Relationship; Self; American Diabetes Association, Centers for Disease Control and Prevention, European Association for the Study of Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. G. Li: None. Funding Centers for Disease Control and Prevention/Chinese Center for Disease Control and Prevention (5U19GH000636-05)

Lifestyle interventions can prevent or delay type 2 diabetes (T2DM) but their long-term effect on cardiovascular disease (CVD) remains unclear. We assessed the effect of lifestyle interventions on the incidence of CVD events among Chinese adults with impaired glucose tolerance (IGT) who participated in the Da Qing Diabetes Prevention Study (DQDPS) and who were followed for up to 30 years after randomization. DQDPS was a 6-year clinical trial conducted in Da Qing, China from 1986 to 1992 in which 576 adults with IGT were randomized by clinic to a control group (138) or one of three lifestyle intervention groups (438) (diet or exercise or both). After the 6-year active intervention, participants were followed to assess their first CVD events until December 31st 2016. CVD was defined as fatal or nonfatal CVD, which included myocardial infarction, congestive heart failure, stroke, and amputation. The intervention effect on CVD was assessed using Cox proportional hazards analysis. 542 (94.1%) of the original participants had data for CVD events. 192 in the combined intervention group and 79 in the control group had a first CVD event during the follow-up. The 30-year cumulative incidence of CVD was 51.8% (95% CI 47.1-56.5) in the intervention group and 65.7% (95% CI 57.8-73.6) in the control group. CVD incidence per 1000 person-years was 21.8 (95% CI 18.8-25.1) in the intervention group compared to 29.0 (95% CI 23.0-36.2) in the control. After accounting for clinic cluster, the intervention reduced the risk of the first CVD event by 27% (HR 0.73, 95% CI 0.55-0.96; p=0.024).Our study is the first to show that a lifestyle intervention program in persons with IGT significantly reduces the incidence of CVD. Our results provide further justification to adopt lifestyle interventions as public health measures to prevent T2DM. Disclosure Q. Gong: None. P. Zhang: None. J. Ma: None. J. Wang: None. Y. An: None. Y.J. Cheng: None. B. Zhang: None. H. Li: None. Y. Chen: None. Y. Hu: None. E.W. Gregg: None. P.H. Bennett: None. G. Li: None.

Aims: To investigate the effects of lifestyle intervention on metabolism profile in people with impaired glucose tolerance (IGT), and potential biomarkers for prevention of diabetes. Methods: The study participants were identified as IGT by OGTT in 1986 and followed in 2006. Sixty participants were selected in the intervention group (I_Group) and 57 in control group (C_Group). UPLC-MS/MS analysis was performed by using the plasma samples. Principal component analysis and orthogonal partial least squares discriminant analysis were used for the data analysis. Results: In 20-year follow-up study, I_Group had lower fasting plasma glucose, triglycerides and urine albumin/creatinine ratio comparing with C_Group. The metabolism profile was significant different between I_Group and C_Group, a total of 65 altered variables were obtained, and 9 metabolic pathways were changed, 4 pathways were considered as the most pertinent in the process of intervention: glycerophospholipid, arachidonic acid (AA) metabolism, glycosylphosphatidylinositol (GPI)-anchor biosynthesis and vitamin B6 metabolism. In I_Group, after 6-year lifestyle intervention, 26 were still in IGT status and 34 change to diabetes after 20-year follow-up. The metabolism profile was significant difference between development of diabetes and still in IGT subjects, a total of 53 altered metabolites were obtained. Compared with the 65 metabolites, 7 metabolites decreased after intervention but increased when they change to diabetes, 1 metabolite had opposite change tendency. The above 8 metabolites involved in 5 metabolic pathways: glycerophospholipid metabolism, GPI-anchor biosynthesis, linoleic acid, α-Linolenic acid, and AA metabolism. Conclusions: The 65 metabolites and 4 metabolic pathways were changed after lifestyle intervention, 8 altered metabolites involved in 5 pathways were considered as the potential biomarkers related to diabetes outcome. Disclosure X. Qian: None. Y. Chen: None. H. Jia: None. Z. Zou: None. Q. Gong: None. Y. An: None. J. Wang: None. H. Li: None. N. Shi: None. G. Li: None.