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October 3, 2013 by NATASHA LONGO
The Largest Clinical Study On Diabetes Out To Prove Which Type of Diet and Exercise Reigns Supreme In Prevention

What a revolutionary concept--diet, exercise and lifestyle modifications to prevent diabetes. It's only been proven empirically millions of times, but researchers want to narrow down exactly what type of diet and exercise work best to prevent the disease which affects over 370 million people worldwide with increasing frequency every year. Eight EU nations, along with New Zealand, Australia and Canada, will participate in an EU-funded project headed by University of Copenhagen researchers.

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 diabetes cases.

The number of people with diabetes has doubled in the past decade, with the ever-mounting and enormous strain upon global health care funding. It is one of the most preventable diseases facing developed nations, yet every year the incidence of diagnoses increases. In the United States Alone, approximately 10% of the population have diabetes with millions of new cases annually.

No Doubt About It--Exercise and Diet Beat Drugs

The evidence of lifestyle modifications, including diet and exercise to curb diabetes is overwhelming.

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 drug metformin in preventing the onset of type 2 diabetes.

The researchers compared the cost-effectiveness of diet and exercise programs in preventing diabetes versus either the use of the drug metformin, or placebo. The diet-exercise program, however, cost society about $8,800 while taking the pill cost about $29,000 per year of healthy life saved. Diet and exercise delayed the onset of type 2 diabetes by about 11 years, while metformin delayed the onset by about three years.

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.

Finnish researchers found that diet and exercise counseling resulted in a 58% reduction in diabetes risk among people who are prime candidates for developing the condition, which is associated with obesity and sedentary lifestyle.

According to two recent Harvard studies, a diet rich in certain high-carbohydrate foods--those low in fiber and with a high glycemic index --increases the risk of Type 2 diabetes, at least in those predisposed to it.

One study tracked 65,000 female nurses (age 40 to 65); the other followed 43,000 male health professionals. Over the course of six years, a total of 1,438 developed diabetes. Men and women whose diet had a high glycemic index and low fiber content more than doubled their chance of developing diabetes. Foods that seemed to pose the greatest risk were white bread, white rice, potatoes, and sugary soft drinks.

The researchers suggested that excessive amounts of carbohydrate-rich foods with a high glycemic index put pressure on the pancreas to produce more of the hormone insulin, which stimulates the body's cells to take in and store glucose. Over time, the body may become resistant to insulin. In such insulin-resistant people, the cells become less and less sensitive to insulin.

Another study by Harvard School of Public Health (HSPH) and University of Southern Denmark researchers found that men who combine weight training and aerobic exercise, such as brisk walking or running, may be able to reduce their risk up to 59% without medication.

Which Diet and Exercise Method Is Most Effective?

Both the barrage of studies and alarming statistics have prompted the EU Commission to deploy funds towards a large research project called PREVIEW. The project seeks to turn the tide and thus ward off a potential explosion in future health care costs related to this lifestyle illness.

The project's aim is to find the most effective combination of diet, exercise and lifestyle related to type-2 diabetes prevention.

"We would like to find out if our current dietary and exercise recommendations are optimal as relates to type-2 diabetes, or whether another lifestyle and regimen is more effective. It could save billions in health care costs for society if we are able to find a formula for how to best prevent type-2 diabetes. In part, we will accomplish this through a large scale, three-year clinical research project with a group of participants from 8 nations, and also by studying data from a range of large demographic surveys," says the project's chief coordinator, Anne Raben, Professor at the University of Copenhagen's Department of Nutrition, Exercise and Sports.

The large clinical study will involve 2500 participants from Finland, the Nederlands, Great Britain, Spain, Bulgaria, Australia, New Zealand and Denmark. Partner universities within these countries have already begun their search for eligible trial participants.

Two Diet Types and Two Forms of Exercise

Trial participants will be randomly divided into groups that each follows a specific lifestyle programme. Each programme will include one of two diet types, and one of two forms of exercise.

The two diet types represent one of the following: one diet is based on current dietary recommendations with high carbohydrate, lots of fiber and a moderate protein intake; and the other, a the other diet includes high protein intake and less, but more slowly absorbed carbohydrates.

The two types of exercise include: one in which participants engage in moderately intense exercise for 150 minutes per week, for example a brisk walk; and another type that focuses on highly intensive exercise for 75 minutes a week, for example jogging.

"We already know that a diet which follows current dietary guidelines can prevent diabetes. What's unique about this project is that we are testing the two diets against one another to find out if there might be a more effective alternative. For example, it has never been investigated whether a diet including more protein and fewer, but more slowly absorbed carbohydrates, is more effective at preventing diabetes. Besides, we will include two types of exercise as part of the investigations to determine if there is one that is more suitable. Finally we will also study the importance of stress and sleeping patterns." continues Professor Anne Raben.

About the Research

PREVIEW is a research project funded by 9 billion euro from the European Commission. In total, there are 15 partners from numerous EU countries, as well as Australia, Canada and New Zealand. The clinical study will include 2500 participants from Denmark, Finland, the Nederlands, Great Britain, Spain, Bulgaria, Australia and New Zealand. Both adults and youth will participate in the study.

2300 participants will be adults in the 25-45 and 55-70 age ranges. The remainder of 200 will be youth in the 12-18 year-old age range. The study is scheduled to last for 3 years and will be active from 2013-2017. In the demographic surveys, data from more than 170,000 people from Europe, Canada and New Zealand will be included.

Natasha Longo has a master's degree in nutrition and is a certified fitness and nutritional counselor. She has consulted on public health policy and procurement in Canada, Australia, Spain, Ireland, England and Germany.

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