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Lifestyle Modification Shown to Be Effective, But Physicians Approach Lacking

Posted: Thursday, February 05, 2004

Individuals with impaired glucose tolerance can reduce their chance of developing the disease by 58% through lifestyle modification.

Clinical research indicates that lifestyle modification is an effective strategy for management and prevention of type 2 diabetes, but a recent review suggests that the best approach for physicians to implement these interventions remains undetermined.

The incidence of type 2 diabetes has grown at an alarming rate in recent years, largely due to more sedentary lifestyles and an increasing rate of obesity.

Stewart B. Harris, MD, MPH, of the University of Western Ontario, Canada, and colleagues performed a review of available data focusing on the role of physical activity and diet modification in the prevention and management of type 2 diabetes.

The researchers identified over 200 relevant publications dating from 1980 to 2001 through a search of electronic databases. Due to the progressive nature of type 2 diabetes and the high attrition rate of lifestyle programs, an emphasis was given to studies that included interventions lasting more than 3 months and reported outcomes after more than 1 year.

According to Dr. Harris, efficacy research was the predominant source of evidence for primary prevention of diabetes using a lifestyle modification approach. Level I evidence demonstrates that both diet modification and exercise can delay the onset of type 2 diabetes, particularly for individuals with impaired glucose tolerance or impaired fasting glucose. Notably, The Diabetes Prevention Program found that individuals with impaired glucose tolerance can reduce their chance of developing the disease by 58% through lifestyle modification. Two major goals of the study were to achieve at least 150 minutes of exercise per week and a minimum weight loss of 7% total body weight.

Weight loss and caloric restriction have also been shown to improve glycemic control for individuals already diagnosed with the disease. Similar to the prevention studies, programs that achieved close to a 7% decrease in body weight produced substantial changes in fasting blood sugar.

Despite the large number of clinical studies supporting the efficacy of lifestyle modification, the researchers identified a "serious gap in the literature with respect to evaluation of the effectiveness of lifestyle intervention in primary healthcare."

The few data available suggested that physician-based interventions had an initial effect on behavior, but had little impact on glycemic control over a longer period. Rather, multi-component interventions involving providers, nurses, dieticians, and links to community resources appear to be more promising.

The researchers advise that, if family physicians are to manage type 2 diabetes more effectively, it will be important to evaluate whether primary health care can foster sustained lifestyle behavior changes. Ultimately however, "whether action is taken depends on individual patients, their families, and support networks," they conclude.