Behavioural Interventions Exercise andor Diet

A number of short-term studies have demonstrated improvements in metabolic parameters among people with IGT after interventions aimed at changing diet and increasing physical activity. They are reviewed in detail elsewhere (3,4,6,11). The results of these studies suggest, but by no means prove, that in the longer term it may be

Table 4.1 Mauritius age-adjusted baseline cardiovascular disease (CVD) characteristics measured in 1987 in men with normal glucose tolerance developing Type 2 diabetes in 1992

CVD risk factor (baseline 1987)

1992 Status Normal glucose tolerance

Converted to diabetes

Body mass index (kg/m2)

22.4

24.3 **

Waist-hip ratio

0.88

0.91 **

Diastolic blood pressure (mmHg)

78.3

82.0 *

Fasting insulin (mU/L)

4.1

6.5 **

2-h insulin (ng/ml)

20.2

35.6 **

2 h plasma glucose (mmol/l)

5.2

6.3 **

Fasting plasma triglycerides (mmol/l)

1.3

19 **

possible to reduce the incidence of Type 2 diabetes. A study from the USA (15), although not population-based, showed that weight reduction in morbidly obese subjects who underwent gastric bypass was associated with a reduced risk of developing diabetes relative to the control group who considered but did not undergo surgery for non-medical reasons. However, the subjects in this study are not representative of the wider population where intervention would be considered.

The Swedish Malmo Study was the first to show that it was feasible to carry out a diet and exercise programme for 5 years in men with IGT and reduce the incidence of Type 2 diabetes by 50% compared with the non-randomized control group (16). In a high-risk Indian community in Tanzania, in which the benefits of exercise and a healthy diet were promoted, the 6-year incidence of Type 2 diabetes in men and women with IGT was a seemingly low 2.2% (17). As there was no control group in this study, it is not possible to determine the programme's effectiveness. The best evidence yet that Type 2 diabetes can be prevented in people with IGT comes from a randomized intervention study reported from DaQing, China (5). Over 6 years there were significant and similar reductions in the incidence of diabetes in subjects with IGT who were randomized to diet, exercise or combined diet-exercise treatment groups (Figure 4.1).

Very recently, Eriksson et al. (18) have reported on the study design and one-year interim report on

Exercise

Figure 4.1 Effects of diet and exercise in preventing Type 2 diabetes in people with impaired glucose tolerance over 6 years in DaQing, China

Exercise

Figure 4.1 Effects of diet and exercise in preventing Type 2 diabetes in people with impaired glucose tolerance over 6 years in DaQing, China

Source: Adapted from Pan X, Li G, Hu Y et al. The DaQing IGT and Diabetes Study. Diabetes Care (1997); 20: 537-544, by permission the feasibility of a major Finnish initiative, the Diabetes Prevention Study. The aim of the study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying Type 2 diabetes in subjects with IGT. A total of 523 overweight IGT subjects have been randomized to a control or intervention group. The interim results show the efficacy and feasibility of the intervention programme. Both weight and plasma glucose (both fasting and post-glucose load) were significantly lower in the intervention group. Favourable changes were also noted in blood pressure, lipids and anthropometric indices (18).

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