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Great News About Avoiding Diabetes

It's only common sense: when people at risk for diabetes get regular exercise, follow a low-fat diet, and lose weight, they improve their chances of staying well. (We're talking about Type 2 diabetes, the common form often called "adult-onset," not Type 1, once called "juvenile diabetes," in which the body stops producing insulin.)

In August "common sense" made national headlines. A study from the National Institutes of Health (NIH) showed that relatively simple measures can lower diabetes risk dramatically. Full results of this study have not been published, but preliminary findings are very impressive. Read on.

The three-year study included 3,234 Americans. All were in a prediabetic state. That is, they had impaired glucose tolerance—their bodies were not processing blood sugar efficiently. One group in the experiment followed a low-fat diet with a view to losing about 7% of their body weight during the first year, and they exercised moderately—half an hour daily. Most of them simply walked. They got counseling about making these changes, as well as follow-up. A second group took metformin (brand name Glucophage, and currently in use to treat diabetes) twice daily. A third group took placebo pills. These other two groups got general advice about healthy habits but no follow-up. Almost 30% of the placebo group developed diabetes during the study. About 22% of those taking metformin did. The most dramatic effect was in the life-style-change group, where only 14% developed diabetes—that's a 58% reduction. The effect was even greater in those over 60.

As reported in September, a major study undertaken in Finland had almost the same results. But nobody was certain that what applied to the Finns would apply to the diverse American population. The new NIH study confirms that it does. All the participants were overweight; their average age was 51, though the age range was 25 to 85. Almost half of them belonged to minorities that have higher rates of diabetes (blacks, Hispanics, people of Asian ancestry, Pacific Islanders, and Native Americans). Some had developed diabetes during pregnancy—a form of diabetes that usually corrects itself after delivery, but increases a woman's future risk.

What does this all prove?

For one thing, metformin may have some use in the prevention of diabetes, but it isn't as effective as diet, exercise, and weight loss. And in this study, it was less effective in preventing diabetes in older people and those who were less severely overweight. Another drawback: the drug can cause diarrhea, and some people had to discontinue it.

An encouraging finding to emerge from the study is that the changes needed to head off diabetes are not drastic—and they work well in all racial, ethnic, and age groups. Study participants increased their intake of fruits and vegetables, and decreased fat. They cut down on sweets, but didn't have to give them up entirely. Weight loss was 5 to 7% of body weight, but nobody had to go hungry. Walking 30 minutes a day, as one researcher pointed out, is a far cry from having to run a marathon.

Industrialized nations, particularly the U.S., are in the midst of an obesity—and hence a diabetes—epidemic. More than 16 million people already have Type 2 diabetes, and the numbers are rising. Diabetes is dangerous and potentially disabling: it can result in kidney failure, amputations, and blindness. Heart disease and stroke are common complications.

But this news could hardly be better. There's a way to prevent or at least delay diabetes—and it's a practical, even easy, way. People will need instruction, along with support and encouragement. If you think you are at risk—that is, you are overweight and sedentary—get a blood test for diabetes. Encourage high-risk members of your family to be tested. In fact, it is recommended that everybody get tested beginning at age 45. However, people at high risk, especially those belonging to a minority group or with a strong family history, should be screened and counseled starting at age 30.

This is one bullet you may well be able to dodge.


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