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Lifestyle changes, drug lower Type 2
Diabetes Risk
Newswise — Intensive lifestyle changes aimed
at modest weight loss reduced the rate of
developing type 2 diabetes by 34 percent
over 10 years in people at high risk for the
disease.
Researchers at Washington University School
of Medicine in St. Louis and 26 other sites
nationwide determined the results from the
Diabetes Prevention Program Outcomes Study (DPPOS),
a 10-year follow-up study of patients who
participated in the Diabetes Prevention
Program (DPP). The results appear in the
Oct. 29, 2009, online edition of The
Lancet.
The DPPOS found that patients at high risk
for developing type 2 diabetes who made
lifestyle changes also had lower blood
pressure and triglyceride levels.
The study also found that those treated with
the oral diabetes drug metformin, rather
than intensive lifestyle changes, reduced
the rate of developing diabetes by 18
percent after 10 years compared with a
placebo.
Completed in 2001, the DPP was a three-year,
randomized trial in more than 3,200
overweight or obese adults with elevated
blood glucose levels, putting them at high
risk to develop type 2 diabetes. Forty-five
percent of participants were from minority
groups disproportionately affected by type 2
diabetes: African-Americans, Hispanic
Americans, Asian Americans, Pacific
Islanders and American Indians.
The DPP results showed that intensive
lifestyle changes, including exercise,
reducing calories and fat intake and
frequent interaction with health-care
professionals, reduced the development of
type 2 diabetes by 58 percent after three
years. Those assigned to two daily doses of
metformin but no lifestyle changes reduced
the development of the disease by 31 percent
over the same period.
Neil H. White, M.D., a Washington University
pediatric diabetes specialist at St. Louis
Children’s Hospital, was the principal
investigator of both studies at the
Washington University School of Medicine
site, which had about 170 adult patients in
the DPP and 140 in the DPPOS.
“Changing one’s lifestyle to better health
habits, including those aimed at reduced
weight, a better diet and more exercise,
will have long-term and sustained impact on
overall health, at least in preventing
diabetes and hopefully in preventing
complications associated with diabetes and
prediabetes,” White says. “Even if the
weight loss is slight, it will have huge
benefits.”
In the United States, about 24 million
adults have diabetes, and up to 95 percent
of them have type 2 diabetes. This type of
diabetes is strongly associated with
obesity, inactivity, family history of
diabetes, history of gestational diabetes,
impaired glucose metabolism and racial or
ethnic background. The prevalence of
diabetes has more than doubled in the last
30 years, due in large part to the upsurge
in obesity.
An additional 57 million overweight adults
have glucose levels that are higher than
normal but not yet in the diabetic range, a
condition that substantially raises the risk
of a heart attack or stroke and of
developing type 2 diabetes.
“In 10 years, participants in the lifestyle
changes group delayed type 2 diabetes by
about four years compared with placebo, and
those in the metformin group delayed it by
two years,” said study chair David M.
Nathan, M.D., of Massachusetts General
Hospital. “The benefits of intensive
lifestyle changes were especially pronounced
in the elderly. People age 60 and older
lowered their rate of developing type 2
diabetes in the next 10 years by about
half.”
White said the participants in the DPPOS
will be followed for another five years to
get information on complications associated
with diabetes and prediabetes over time,
including eye, kidney and heart disease
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