Randomized Trial Demonstrates
Benefits of Lifestyle Modification in Type 2 Diabetes
First randomised trial ever to report that
people who have a high risk of developing type
2 diabetes mellitus can prevent the disease.
Obesity and physical inactivity have been linked
unequivocally to the onset of diabetes. People
with impaired glucose tolerance are known to be
at increased risk of diabetes and cardiovascular
complications of hyperglycemia and should therefore
be a focus of prevention efforts, note researchers
led by Jaakko Tuomilehto, MD, with the National
Public Health Institute, Helsinki, Finland.
To evaluate the effect of lifestyle modification
on development of diabetes, the researchers randomized
522 middle-aged, overweight subjects with impaired
glucose tolerance to either lifestyle intervention
or no intervention. All participants underwent
an oral glucose tolerance test annually.
Subjects in the intervention group were given
individualised detailed advice about how to achieve
the intervention goals. These included weight
loss of 5% or more, total daily fat intake of
less than 30% of calories, daily saturated fat
intake of less than 10% of calories, daily fibre
intake of 15 g per 1,000 calories, and moderate
daily exercise for 30 minutes or more.
Overall, the intervention group lost more average
weight than the control group. The mean weight
reduction from baseline to year 1 was 4.2 kg and
from baseline to year 2 was 3.5 in the intervention
group and 0.8 kg at both time points in the control
group, respectively (P<0.001 between the groups).
During a mean follow-up of about 3 years, the
risk of diabetes was reduced by 58% (P<0.001)
in the intervention group compared with the control
group.
"Based on our study, 22 subjects with impaired
glucose tolerance need to be treated for 1 year
or 5 people for 5 years with a lifestyle intervention
to prevent 1 case of diabetes," Dr. Tuomilehto
and colleagues predict.
They conclude that primary prevention of diabetes
is possible by a nonpharmacological intervention
that can be implemented in a primary care setting.
J Am Soc Nephrol 2003;14:7 Suppl 2:S108-13.
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