By Melinda T. Willis
ABCNEWS.com
For individuals at high risk for
developing diabetes, prevention may be a brisk walk away. A new study
finds that lifestyle changes, including a healthy diet and moderate
activity, outperform medications in preventing the onset of type 2
diabetes.
The study, published in this week's New England Journal of Medicine
(news - web sites) , 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 (news - web sites)
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 per
week.
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 United States.
"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.
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.