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American Diabetes Association Scientific Sessions
June 25, 2011
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Patients with newly diagnosed diabetes benefited from early dietary intervention

ADA 71st Scientific Sessions

SAN DIEGO — An intensive dietary intervention and an intensive intervention combining diet and exercise produced comparable improvements in glycemic control, body weight, cholesterol and triglyceride levels when implemented soon after diagnosis in patients with type 2 diabetes, with exercise conferring no additional benefit when combined with diet intervention, a presenter said here.

“What our study aimed to do was add to what we know — that people who exercise and stick to a diet in controlled trials significantly improve their diabetes control,” Robert C. Andrews, MB, ChB, PhD, lead researcher of the Early Activity in Diabetes (Early ACTID) trial and senior lecturer at the University of Bristol, said during a press conference. The ultimate goal of Early ACTID, he added, was to determine whether intensive interventions targeting diet, exercise or both were superior to the typical care received by patients with newly diagnosed diabetes.

Early intervention

Andrews and colleagues studied 593 adults (mean age, 60 years) from primary care who had been diagnosed with type 2 diabetes within the previous 5 to 8 months. Patients were randomly assigned to usual care, an intensive dietary program or an intensive intervention addressing both diet and physical activity. Usual care involved an initial consultation regarding diet and exercise and follow-up at 6 months; the intensive dietary intervention encouraged patients to lose 5% to 10% of their body weight and included dietary consultation every 3 months with monthly nurse support. The combination diet and exercise intervention also added five 30-minute brisk walking sessions per week to patients’ regimens. Altogether, patients in the intervention arms received an additional 6.5 hours of individual dietary counseling per year, Andrews said.

Results indicated that patients in the intervention groups each experienced approximately 10% improvements in glycemic control, cholesterol and triglyceride levels when compared with patients assigned to usual care. In the routine care group, HbA1c levels increased from 6.72% at baseline to 6.86% at 6 months. In contrast, HbA1c decreased by 0.28% in the diet group and by 0.33% in the diet plus exercise intervention group. Further, patients receiving routine care were three times more likely to initiate diabetes medication use before the study’s conclusion compared with the intervention groups. Both programs also experienced about a 4% reduction in body weight, the researchers reported.

Andrews said there were no major differences between intervention arms in terms of weight loss, glucose control or drugs used.

The study results were simultaneously published in The Lancet.

Implications

Andrews explained that two major reasons may account for the lack of benefit associated with increasing patients’ physical activity.

“We based our intervention on walking instruction because we wanted something very simple … that could be rolled out in primary care,” he said, noting that a combination of aerobic and anaerobic exercise may have been more effective. “Also, the majority of people, when they exercise, tend to reward themselves with extra food … meaning [the study participants] might not have been sticking to the diet as rigidly.”

Nevertheless, exercise remains an essential part of diabetes management. Andrews cautioned against using the study’s findings to downplay its importance.

“Getting people to exercise is quite difficult and can be expensive. What this study tells us is that if you only have a limited amount of money, in that first year of diagnosis, you should focus on getting the diet right,” he said in a press release. “Glycemic control gets worse over time. In the early stages, people tend to make rapid improvements and then it stays the same for a while. Adding exercise later might provide another boost in control whereas it wouldn’t early on.”

In an accompanying editorial, also published in The Lancet, Frank B. Hu, MD, MPH, PhD, of the Harvard School of Public Health, said more research into the long-term effects and cost-effectiveness of these interventions is needed.

“There is little doubt that improved nutrition and physical activity are beneficial for individuals with or without diabetes, and research into the most effective way to deliver these benefits (including individual behavioral changes and creation of a supportive food and social environment) deserves high priority,” he wrote. – by Melissa Foster

For more information:

Disclosure: Dr. Andrews reports receiving honoraria from GlaxoSmithKline, Novo Nordisk, Sanofi-Aventis and Lilly, and travel expenses from Sanofi-Aventis. Dr. Hu reports receiving grants from Merck and the California Walnut Commission and lecture fees from Nutrition Impact, Unilever and the Institute of Food Technologies.

PERSPECTIVE

I was a little surprised that exercise in addition to diet did not make a difference, but I think it is somewhat consistent with findings from the Diabetes Prevention Program (DPP) trial. If you analyze people in the DPP, it really was the weight loss that made a difference, and exercise by itself was not independently linked to diabetes prevention. However, it is important to note that patients in either lifestyle arm did so much better than the routine care patients. The [overall] message is that we should not pay short shrift to lifestyle therapies and dietary therapies.

- Sue Kirkman, MD
Vice President, Medical Affairs and Community Information
American Diabetes Association

Disclosure: Dr. Kirkman reports no relevant financial disclosures.

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