Recent studies on diabetes and the benefit of good glucose control

This is the abstract of a study comparing "lifestyle intervention" to drug therapy.

Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA.

BACKGROUND: Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. METHODS: We randomly assigned 3234 non-diabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. RESULTS: The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-

intervention program, and 13.9 would have to receive metformin. CONCLUSIONS: Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.

PMID: 11832527 [PubMed - indexed for MEDLINE]

The importance of managing type 2 diabetes by diet and lifestyle adjustments (call commonly 'lifestyle intervention' in the medical jargon).

In this study, the diabetes medication 'Metformin' was compared to a placebo, and to a 'lifestyle intervention' (weight loss and exercise through better diet and a very modest exercise program). The original article as in 'The New England Journal of Medicine', Feb 7, 2002 titled "Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin" and performed by the Diabetes Prevention Program Research Group".

In the study of over 3000 adult non-diabetics at high risk for developing type 2 diabetes, after just under 3 years in the study, the metformin only reduced the incidence of type 2 diabetes by 31% while the lifestyle intervention program reduced the incidence of type 2 diabetes by 58% (both relative to the placebo). That is a huge difference.

Not only did the lifestyle change dramatically reduce the chance that the people in the study developed type 2 diabetes, but the lifestyle intervention far exceeded the medication in its protective health benefits against developing type 2 diabetes.

The message here is that the most important thing you can do to fight type 2 diabetes is to modify your diet and lifestyle. You may require medications eventually as well, but your most important weapon against type 2 diabetes is your choosing to live a healthy lifestyle (exercise and diet)

In this book I am trying to bring you the best methods of controlling type 2 diabetes with diet.

There are two additional studies that should be considered in this equation. They are the ACCORD study and the ADVANCE study.

ACCORD Study

Position Statement: The National Heart, Lung, and Blood Institute Issue: Part of ACCORD study halted due to safety concerns

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has halted the intensive blood-glucose lowering arm of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study 18 months early due to safety concerns.

This trial, carried out in 10,251 adults with type 2 diabetes at especially high risk for heart attack and stroke, was designed to compare the effect of two treatment strategies on the risk of cardiovascular events such as heart attack, stroke, or death from cardiovascular disease.

Participants were assigned to receive one of two strategies: treatment to intensively lower blood glucose below current recommendations or treatment with a less-intensive standard strategy. Over an average of almost four years, 257 people in the intensive treatment group have died, compared with 203 within the standard treatment group. This is a difference of 54 deaths, or 3 per 1,000 participants each year (although the death rates in both treatment groups are lower than rates seen in similar populations in other studies). Based on available analyses there is no evidence that any one medication or any particular combination of medications is responsible for these deaths.

While the exact reasons for these findings are unclear, they do suggest that intensive treatment to target blood glucose levels below an A1C of 6.0% may not be appropriate for some patients, especially those at high risk of heart attack or stroke and with poor initial glycemic control. A target A1C =7.0% (as recommended for most patients with diabetes in the 2003 Canadian Diabetes Association's Clinical Practice Guidelines) offers physicians the option of aiming lower if they feel it is safe in an individual patient.

The ACCORD findings do not apply to people with type 1 diabetes, and it is unclear whether they apply to patients recently diagnosed with type 2 diabetes or those who have a lower cardiovascular risk than the participants in ACCORD.

It is important that people with diabetes not make any changes to their treatments or adjust their blood glucose targets without speaking to their healthcare team. In addition to blood glucose control, people with diabetes can reduce their overall cardiovascular risk by controlling their blood pressure and cholesterol levels and by adopting a healthy lifestyle that includes quitting smoking.

The ACCORD trial will continue, with participants in the intensive treatment arm now receiving standard treatment instead.

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