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Diet, Exercise Delay Type 2 Diabetes

At least 10 million Americans at high risk for Type 2 diabetes can
sharply lower their chances of getting the disease with diet and
exercise, a major clinical trial indicates.

"In view of the rapidly rising rates of obesity and diabetes in
America, this good news couldn't come at a better time," said Health
and Human Services Secretary Tommy G. Thompson in announcing the
findings Aug. 9 at the National Institutes of Health (NIH). "So many
of our health problems can be avoided through diet, exercise and
making sure we take care of ourselves."

The study also found that treatment with the oral diabetes drug
Glucophage (metformin) reduces diabetes risk, though less
dramatically, in people at high risk for Type 2 diabetes.

Participants who were randomly assigned to intensive lifestyle
intervention reduced their risk of getting Type 2 diabetes by 58
percent. On average, this group maintained their physical activity at
30 minutes a day, usually with walking or other moderate-intensity
exercise, and lost 5 percent to 7 percent of their body
weight. Participants picked randomly to receive treatment with
Glucophage reduced their risk of getting Type 2 diabetes by 31
percent.

The study, called the Diabetes Prevention Program (DPP), compared diet
and exercise to treatment with Glucophage in 3,234 people with
impaired glucose tolerance (IGT), a condition that often precedes
diabetes. The trial ended a year early because the data had clearly
answered the main research questions.

The DPP, conducted at 27 centers nationwide, is sponsored by the
NIH. It is the first major trial to show that diet and exercise can
effectively delay diabetes in a diverse American population of
overweight people with IGT, a condition in which blood glucose levels
are higher than normal but the individual is not yet considered to
have diabetes.

Forty-five percent of the participants enrolled in the DPP were from
minority groups that suffer disproportionately from Type 2 diabetes:
African Americans, Hispanic Americans, Asian Americans and Pacific
Islanders, and American Indians. The trial also recruited other groups
known to be at higher risk for Type 2 diabetes, including people age
60 and older, women with a history of gestational diabetes, and people
with a first-degree relative with Type 2 diabetes.

Lifestyle intervention worked as well in men and women and in all the
ethnic groups, according to the study's chairman, David Nathan, M.D.,
of Massachusetts General Hospital in Boston. It also worked well in
people age 60 and older, reducing the development of diabetes in this
group by 71 percent. Glucophage was effective in men and women and in
all the ethnic groups, but was relatively ineffective in the older
volunteers and in those who were less overweight.

DPP volunteers were randomly assigned to one of the following groups:

intensive lifestyle changes with the aim of reducing weight by 7
percent through a low-fat diet and exercising for 150 minutes a week;
treatment with Glucophage (850 mg twice a day), a drug approved in
1995 to treat Type 2 diabetes; or standard group taking placebo pills
in place of Glucophage.
The latter two groups also received information on diet and exercise.

DPP participants ranged from age 25 to 85, with an average age of
51. Upon entry to the study, all had impaired glucose tolerance as
measured by an oral glucose tolerance test, and all were overweight,
with an average body mass index (BMI) of 34. (A BMI of 25 or more--or
27 after age 35--indicates obesity.) About 29 percent of the DPP
standard group developed diabetes during the average follow-up period
of three years. In contrast, 14 percent of the diet and exercise group
and 22 percent of the Glucophage group developed diabetes.

Volunteers in the diet and exercise group achieved the study goal, on
average a 7 percent--or 15-pound--weight loss, in the first year and
generally sustained a 5 percent total loss for the study's
duration. Participants in this lifestyle intervention group received
training in diet, exercise (most chose walking), and behavior
modification skills.

Can the interventions prevent diabetes altogether? "We simply don't
know how long, beyond the 3-year period studied, diabetes can be
delayed," says Nathan. "We hope to follow the DPP population to learn
how long the interventions are effective." The researchers will
analyze the data to determine whether the interventions reduced
cardiovascular disease and atherosclerosis, major causes of death in
people with diabetes.

SOURCE: FDA Consumer
       

       
               
               

               

               
               



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