Medication to Prevent Diabetes

The Big Diabetes Lie

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The Diabetes Prevention Program study tested not only the impact of lifestyle. It also tested the value of a medicine, metformin, in preventing diabetes. Metformin is a medicine that is commonly used to treat diabetes. It works primarily by decreasing the amount of sugar made by the liver and by reducing insulin resistance. 139^

As reviewed in Chapter 2, type 2 diabetes develops gradually. In the years that it is developing, but before it causes symptoms or blood test abnormalities that lead to its diagnosis, there is slowly increasing insulin resistance. The resistance of the body's tissues to the effects of insulin causes blood-sugar levels to rise, especially after meals. This, in turn, causes the pancreas to make more insulin. Eventually, the pancreas becomes fatigued from overwork, insulin secretion fails, and full-blown type 2 diabetes results.

Because slowly developing insulin resistance underlies type 2 diabetes, it made sense that using a medication that reduces insulin resistance might prevent diabetes. We found that metformin worked. It reduced the risk of developing diabetes by 31 percent, a significant decrease. However, it did not work as well as lifestyle modification, which reduced the risk of diabetes by 58 percent. And, as with any medication, metformin carries some risk of side effects. Lifestyle modification, in contrast, has few side effects. We did not test the combination of lifestyle modification and metformin to see if it might have reduced the risk of diabetes even more than 58 percent.

Future studies may show that a combination of medication and lifestyle modification is the most potent way to prevent diabetes. Indeed, for the treatment (as contrasted to the prevention) of several major chronic diseases, the combination of lifestyle change and medications is often advised. And, sometimes, the lifestyle intervention can eliminate, or at least reduce, the need for medications.

In summary, the DPP study showed that lifestyle changes had a greater power to prevent diabetes than the medicine we tested. The lifestyle program that the people in our study were asked to adopt proved feasible for them. Lifestyle changes should be suitable for you, too. We hope that this book will provide not only the rationale but scientifically proven guidance as to how you can change your lifestyle to a healthier one that can prevent diabetes and its complications.


Applying Lifestyle Changes to Treat Diabetes and Associated Diseases

Unlike Superman, who is able to reverse life events by flying really fast, we cannot live life backward. Therefore, if you have already developed type 2 diabetes, you may wonder whether the lifestyle changes that could have prevented diabetes will gain you anything. The answer is yes: the same lifestyle changes that might have prevented your diabetes can help you to treat it.

As important as lifestyle is in causing type 2 diabetes, it may be even more important in treating type 2 diabetes, as well as type 1 diabetes. Diabetes is a unique chronic disease, affected by virtually every aspect of lifestyle, including eating, physical activity, and school, work, and travel schedules. Conversely, all of these activities are affected by diabetes. While many diseases require attention to taking prescribed medications, diabetes demands constant attention and vigilance with regard to timing and content of meals and physical activity, glucose monitoring, administration of numerous medications including insulin, foot care, and a host of other self-care requirements. -And diabetes can be a petulant, L41

jealous companion: if you ignore your care, even for a little while, it will make you pay with uncomfortable and potentially dangerous hyperglycemia or hypoglycemia. And if you do not pay attention to the myriad details of care over a long period of time, the penalty can be much more severe with loss of vision, kidney failure, foot ulcers, amputations, and heart disease.

On the bright side, during the past two decades, clinical trials have shown us that persons with diabetes can live long, productive, and complication-free lives. Studies in both type 1 and type 2 diabetes have demonstrated how to achieve near-normal blood-glucose (and hemoglobin A1c—the measure of long-term, average blood glucose) levels. In addition, we have developed effective interventions to lower blood pressure and cholesterol levels in people with diabetes. The consequence of such "tight" glucose, blood pressure, and cholesterol control is improved long-term health. Blood-sugar levels maintained in the near-normal range over time effectively reduce the development and progression of the eye, kidney, and nerve complications that would otherwise rob people of their sight, kidney function, and limbs. In addition, aggressive blood pressure control benefits eye and kidney disease and reduces the risk of heart disease and stroke. Similarly, lowering LDL (bad) cholesterol decreases heart disease.

How does lifestyle enter into the treatment of diabetes? In this chapter, we describe the role of lifestyle in the management of blood-sugar levels in type 1 and type 2 diabetes and the importance of lifestyle in managing the other important risk factors such as hypertension and dyslipidemia (abnormal cholesterol and other fats in the blood). This is often referred to as the lifestyle approach to the ABCs of diabetes management: A1c (hemoglobin A1c), blood pressure, and cholesterol.

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