Diet, Exercise Top Drugs
in Preventing Diabetes
Preventing diabetes with diet and exercise
may be not only possible, especially among nonsmokers, but also
more cost-effective than medication.
So say two studies appearing in
the March 1 issue of the Annals of Internal Medicine.
One study found diet and exercise
modifications reduced the risk of developing diabetes in nonsmoking
men. The second study, a computer simulation, found a diet and
exercise program was cheaper than using a pill when it came to
preventing the disease.
The issue of preventing type 2
diabetes is looming as one of the most pressing public health
issues of the 21st century, with two-thirds of U.S. adults now
overweight or obese. The number of people diagnosed with type
2 diabetes is rising even as the age at which they are diagnosed
The Diabetes Prevention Program
(DPP), a trial published in 2002, found intensive lifestyle interventions
such as diet or exercise were more effective than the diabetes
pill metformin in preventing the onset of type 2 diabetes. The
trial involved people with impaired glucose tolerance, often a
precursor to diabetes.
Since then, the question has been:
how to make such lifestyle programs work.
"There has been a debate about
how to implement lifestyle intervention," said study author Dr.
William Herman, a professor of internal medicine at the University
of Michigan School of Medicine. "The word on the street is that
it can't be done. It's too expensive." Herman himself used to
belong to this camp, he noted.
What changed his mind was this
study, which involved a computer simulation using data from the
DPP. The researchers compared the cost-effectiveness of diet and
exercise programs in preventing diabetes versus either the use
of the drug metformin, or placebo.
Both the lifestyle program and
the metformin program reduced the risk of developing diabetes
among people with abnormal blood sugar levels. The diet-exercise
program, however, cost society about $8,800 while taking the
pill cost about $29,000 per year of healthy life saved. Unlike
the lifestyle strategy, the metformin program was not cost-effective
after the age of 65, the researchers added.
Diet and exercise delayed the onset
of type 2 diabetes by about 11 years, while metformin delayed
the onset by about three years.
"The bottom line is that is even
though everything but the kitchen sink was thrown in, the intensive
lifestyle intervention is more cost-effective than a pill," Herman
said. "We have to find better ways to implement it in clinical
public health practice."
One such way would be to convince
public and private health insurance programs to cover things such
as health club memberships, Herman said.
Some are not convinced by the findings,
"This was a hard pill for me to
swallow," said Dr. Stuart Weiss, an assistant professor of clinical
medicine at New York University School of Medicine. "I have very
few patients who will go to a class on lifestyle issues." That
means Weiss has to spend time in face-to-face discussions with
Also, he added, many classes are
not effective and may even teach participants bad habits.
Dr. Nathaniel Clark, national vice
president for clinical affairs at the American Diabetes Association,
said doctors need to focus on individual patients before thinking
about cost-effectiveness across health plans, or in the health-care
system as a whole.
"The first thing we need is to
motivate the patient to make the lifestyle change or this type
of study will do nothing," he said. "One would hope it would be
helpful in getting either the health-care system or health plan
to ask, 'Is it worth my investment to pay for these sorts of services?'"
The second study involved 11,827
men who had normal glucose levels at the beginning of the trial.
Some of the men were assigned to a program aimed at modifying
their diet, helping them to quit smoking and increasing physical
activity, while the others were provided with "usual care."
Overall, roughly the same percentage
of people in both groups (about 11 percent) developed diabetes
over a six-year period. However, nonsmokers in the lifestyle program
were less likely to develop diabetes than nonsmokers in the usual
"This study gives tremendous support
for the concept that we shouldn't look only for people who have
abnormal blood glucose levels and say 'You need to lose weight
and be more active.' We should really be doing that as a society,"
Clark said. "Let's try to move further and further back down the
time frame, so that ultimately the goal is really to have people
be born healthy and then remain healthy through their lives."
Both studies seemed to be giving
the same message: lifestyle programs work.
"If patients ate properly and exercised
well, then diabetes would definitely not be as big an issue,"
Weiss said. "Evidence is accumulating, and we just need for people
to accept it and move away from the kitchen."
The National Institute of Diabetes
and Digestive and Kidney Diseases can tell you more about type
Reference Source 101
March 1, 2005