Diet, Moderate Exercise Reduce Diabetes Risk Better Than Drugs
The study, published in this week's New England Journal of
Medicine, presents the results of a large randomized trial
conducted by the Diabetes Prevention Program Research Group between
1996 and 1999. The results were previously announced in a news
conference given by Health and Human Services Secretary Tommy
Thompson in November.
Researchers randomly assigned 3,234 nondiabetic people at high
risk for developing diabetes to receive a placebo, the drug Glucophage
or to participate in a lifestyle modification program. The goals
of lifestyle modification included at least a 7 percent reduction
in weight and at least 150 minutes of moderate intensity activity
The groups were followed for an average of approximately three
years to see which groups eventually developed diabetes.
The lifestyle intervention reduced the incidence of diabetes
by 58 percent compared to the placebo. Glucophage also reduced
diabetes incidence compared to the placebo, but only by 31 percent.
Drugs vs. Lifestyle
Many experts are encouraged by these findings and feel that
they will have considerable impact for millions of people in the
"This study is a big deal with considerable implications for
public health and clinical practice," says Charles Clark, director
of the Indiana University Diabetes Research and Training Center.
"There are probably 12 million people who meet the criteria [of
the study] and an equal number who are at somewhat less risk."
Type 2, or adult onset diabetes, is a metabolic disorder that
results when the body cannot make enough or properly use insulin,
a hormone that converts food to energy. This differs from type
1 diabetes, in which people must take daily insulin shots because
their bodies don't produce any insulin, and is most commonly diagnosed
in children and young adults. According to the American Diabetes
Association, type 2 diabetes accounts for 90 to 95 percent of
While lifestyle changes may be more difficult to make and adhere
to than taking a pill, experts say that making the transition
to a healthy diet and regular exercise is key.
"The important points of the study are that minimal changes
in lifestyle are within the possibility of many different free-living
individuals of different ethnicity and culture, and that it works
better than medications," says Dr. Philip Orlander, professor
and director of endocrinology at the University of Texas, Houston.
Even though Glucophage proved to have preventative benefits,
Orlander feels it would be unfortunate if the take-away message
was that, "pills are easier to take than exercising 20 minutes
a day and are almost as good."
An Ounce of Prevention
These findings are also significant because experts say that
preventing diabetes before it develops is less difficult than
controlling the disease after onset.
"Currently only 15 percent of people with type 2 diabetes are
controlled with diet and exercise alone," says Dr. Steven Edelman,
professor of medicine in the Division of Diabetes and Metabolism
at the University of California, San Diego, School of Medicine.
"The main reason for this is that they are too far advanced in
their natural history and multiple drugs/insulin are needed to
control the diabetes, which is not easy."
Physicians say these findings will help them make recommendations
for people who are at high risk for developing the disease.
"We need not wait for them to get diabetes and the complications
of diabetes," Dr. David Nathan of Massachusetts General Hospital
in Boston told ABCNEWS Medical Correspondent John McKenzie on
World News Tonight. "We can do something earlier."
"The bottom line is that when interventions are introduced early
in the natural history of diabetes, it is possible to make significant
impact," says Edelman.
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