Diet Beats Drugs for Diabetes Prevention
Study Shows Lifestyle Changes Are More Effective Than Drugs in Preventing Diabetes
By
Salynn Boyles
WebMD Health News
Reviewed By
Brunilda Nazario, MD
Oct. 28, 2009 -- Lifestyle changes resulting in long-term weight loss of
just a few pounds proved to be roughly twice as effective as drug treatment for
preventing type 2 diabetes in an ongoing government-sponsored trial.
Researchers followed almost 3,000 high-risk patients for a decade in one of
the largest and longest studies aimed at preventing diabetes ever
conducted in the U.S.
Roughly a third of the participants were initially asked to eat a low-fat
diet and engage in at least 30 minutes of moderate activity a minimum of five
times a week, with the goal of losing 7% of their body weight within a
year.
Another third were put on the diabetes drug metformin; the remaining
patients initially received no intervention.
Many of the people in the lifestyle intervention group met the weight loss
goal, losing an average of 15 pounds during the first year of the study.
While they regained, on average, 10 of those pounds during the next seven
years, the lifestyle intervention group continued to have the lowest rates of
diabetes.
"Weight loss is still the most important thing we have to recommend to
overweight people at risk for type 2 diabetes," William C. Knowler, MD, of the
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), tells
WebMD. "This study shows that the benefits of even modest weight loss can
persist for many years."
Reduction in Diabetes Incidence
Three years into the trial, Knowler and colleagues reported that diabetes
incidence was reduced by a whopping 58% in the lifestyle intervention group and
31% in the metformin group, compared to people who received no
intervention.
This dramatic difference led the researchers to offer lifestyle
intervention, in the form of group counseling and support sessions, to all
three groups for the rest of the study.
The 10-year follow up analysis, which appears Thursday in TheLancet, shows that:
- Compared to the non-intervention group, patients in the intensive lifestyle
intervention group and metformin group, respectively, were 34% and 18% less
likely to develop diabetes over 10 years.
- Lifestyle intervention was found to delay the onset of diabetes by four
years. Drug treatment delayed diabetes by two years.
- The benefits of intensive lifestyle intervention were particularly strong
in the elderly. Those aged 60 and older in the diet and exercise group lowered
their rate of developing diabetes by half over 10 years.
"Lifestyle and metformin were both useful for delaying or preventing
diabetes," says endocrinologist and co-researcher Ronald Goldberg, MD.
The researchers will continue to follow the study participants for at least
another five years. One goal of the continued follow-up is to determine the
impact of the lifestyle and drug interventions on the development of diabetes
complications, such as nerve damage and blindness.
Diabetes on the Rise
About one in 10 adults in the U.S. -- roughly 24 million people -- have
diabetes, and an additional 57 million are at risk for developing the disease
because they are overweight or obese and have impaired blood sugar control.
Goldberg says the study findings highlight the importance of making
prevention and lifestyle interventions a focus of national health care reform.
He is professor of medicine in the division of endocrinology, diabetes, and
metabolism at the Diabetes Research Institute, University of Miami Miller
School of Medicine.
"The biggest expense in diabetes comes from treating the complications of
disease," he says. "If we can show that these interventions keep people from
developing these complications, this could have an enormous impact."
SOURCES: Knowler, W.C. The Lancet, Oct. 29, 2009; online edition.
William C. Knowler, MD, chief, diabetes, epidemiology, and clinical research section, National Institute of Diabetes and Digestive and Kidney Diseases.
Ronald Goldberg, MD, professor of medicine, division of endocrinology, diabetes and metabolism, Diabetes Research Institute, University of Miami Miller School of Medicine.
News release, The Lancet.
News release, National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases.
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