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Intensive lifestyle interventions benefit patients with type 2 diabetes
Lifestyle interventions can have a number of positive effects in the management of type 2 diabetes.
It has been well documented in two landmark clinical trials on the prevention of diabetes that dietary changes and regular physical activity will prevent or delay the development of diabetes in high-risk individuals.
Landmark clinical trials
The Diabetes Prevention Project (DPP), a randomized controlled trial in patients with prediabetes, showed that 7% weight loss, achieved by a lifestyle modification program, reduced the 4-year cumulative incidence of diabetes by 58% vs. a placebo group that made no formal lifestyle changes. The program incorporated individual and group counseling sessions that encouraged a low-fat diet and at least 150 minutes of exercise (brisk walking) per week.
James R. Taylor
The Finnish Diabetes Prevention Study extended the DPP by looking at the reduction in the incidence of diabetes in high-risk, middle-aged (mean age, 55 years) adults at as much as 5 years post-intervention. The intervention included personal counseling sessions aimed at moderate (5%) weight loss achieved by a low-fat, high-fiber diet and moderate exercise for about 30 minutes per day. The average weight loss at 5 years was only 4.6 lb, but resulted in a lower incidence of diabetes in this population (23%) vs. placebo (11%).
Modest reductions in weight using a combination of dietary modifications and exercise resulted in significant reductions in the incidence of diabetes in high-risk individuals.
Look AHEAD
A more recent analysis of the Action for Health in Diabetes (Look AHEAD) study by Gregg and colleagues examined the association of a long-term intensive weight-loss intervention with the frequency of remission of type 2 diabetes. This was a randomized controlled trial involving more than 4,500 participants followed for 4 years. All participants had type 2 diabetes and a BMI of at least 25 at the beginning of the study. They were randomly assigned to intensive lifestyle intervention or a standard lifestyle intervention.
The intensive intervention involved weekly counseling for the first 6 months, then three sessions per month for 6 months, followed by two sessions per month for remainder of study. The primary aim of the intensive group was a reduction in total caloric intake to 1,200 kcal/day to 1,800 kcal/day, along with 175 minutes/week of exercise.
The standard group received three counseling sessions per year focusing on diet, exercise and social support. The results showed that the intensive intervention group lost significantly more weight and had greater fitness increases. The intensive group also was more likely to achieve remission of their diabetes vs. the control group (7.3% vs. 2%, respectively). It should be noted that more patients achieved partial remission than complete remission. This lends some support to more intensive lifestyle interventions than what is commonly done for many patients with type 2 diabetes.
For more information:
- Gregg EW. JAMA. 2012;308:2489-2496.
- Knowler WC. N Engl J Med. 2002;346:393-403.
- Tuomilehto J. N Engl J Med. 2001;344:1343-1350.
Disclosure:
- James R. Taylor, PharmD, CDE, is a clinical associate professor in the department of pharmacy practice at the University of Florida, Gainesville. He can be reached at University of Florida, College of Pharmacy, P.O. Box 100486, Gainesville, FL 32610-0486; email: jtaylor@cop.ufl.edu. He reports no relevant financial disclosures.