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Lifestyle Interventions for Patients with Impaired Glucose Tolerance

May 28, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Maya Rudolph, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate

Impaired glucose tolerance causes a decrease in quality of life, which can increase morbidity and mortality.

Type 2 diabetes can lead to different macrovascular and microvascular complications, reduced quality of life, and reduced life expectance. In 2015, diabetes remains the 7th leading cause of death in the United States, with 79,535 deaths that were attributed to the disease. Almost half of all deaths associated to high blood glucose occurred before the age of 70 years. Future forecasters predict the prevalence of diabetes will increase by 54% to more than 54.9 million Americans between 2015 and 2030; annual deaths will rise by 38% to 385,800. About 35% of the U.S. population is obese, linking to the rise in incidence of type 2 diabetes.

Comorbidities and complications of this disease cause a decrease in quality of life, which can lead to depression or increased morbidity and mortality. Reducing the burden of type 2 diabetes will require implementation of lifestyle changes. Proper lifestyle interventions can help control weight loss, diet, and physical activity. Recent studies have suggested that lifestyle interventions can prevent or delay the progression of type 2 diabetes. The uncertainty still lies in whether lifestyle interventions lead to fewer complications or decrease the risk of morbidity and mortality.

A cluster, randomized trial observed lifestyle interventions in 577 adults with impaired glucose tolerance. The study took place in Da Qing, China, where 33 clinics were assigned to either be a control clinic or to offer one of the three lifestyle interventions: 1) dietary intervention that consisted of increased vegetable intake and lower alcohol and sugar intake; 2) exercise intervention which consisted of partaking in leisure time physical activity; or 3) diet plus exercise. Active interventions were held for 6 years. For participants who were overweight (BMI >25 kg/m2), all interventions groups stressed the importance of weight loss and decreased caloric intake. Participants were assessed for a duration of 30 years on the incidence of type 2 diabetes control, cardiovascular disease events, microvascular complications, cardiovascular disease death, all disease caused mortality, and life expectancy. The control group was assigned 138 participants and 438 participants were assigned to the intervention group.

At completion of the 30-year follow-up, 540 of the 576 participants were evaluated for outcomes: 135 in the control group and 405 in the intervention groups. The delay in diabetes onset in the combined intervention group (including diet and exercise) was 3.96 years. Compared to the control group, the combined intervention group reported significant reductions of 26% in cardiovascular events, 35% reduction in microvascular complications, 33% reduction in cardiovascular mortality rates, and a 26% reduction in all disease caused mortality. Results also showed an increase in median survival rate of 4.82 years and an increase of life expectancy of 1.44 years. To prevent the onset of type 2 diabetes, CVD death, or other microvascular complications the number needed to treat was 10 per outcome.

Lifestyle interventions were proven to delay the onset of type 2 diabetes in patients with impaired glucose tolerance. Reduction of cardiovascular events, microvascular complications, cardiovascular and all disease caused mortality, and increased life expectancy are all plausible from lifestyle interventions.  Results as significant as these in the trial can be used to help many medical providers increase the life expectancy in their patients with type 2 diabetes with other microvascular/macrovascular complications. This study provides strong evidence that implementation of diet and exercise should be considered in all patients with type 2 diabetes or prediabetes.

Long duration lifestyle interventions can slow the progression of type 2 diabetes under trial conditions. This trial lasted for 30 years, which possibly could have led to its success, due to participants and providers developing a strong alliance to meet goal during the extended time.  Due to the extended time of the interventions and routine clinical settings, this study can appear to be more valuable in real world implementation.

Practice Pearls:

  • Overall morbidity and mortality risk and increased life expectancy improved by 1.44 years due to lifestyle interventions in patients with impaired glucose tolerance.
  • Lifestyle interventions that patients with impaired glucose tolerance can implement are dietary changes and increased physical activity.
  • The study concluded that proper lifestyle interventions can delay the onset of type 2 diabetes with a mean of 3.96 years.

References:

Howells, Lara, et al. “Clinical Impact of Lifestyle Interventions for the Prevention of Diabetes: an Overview of Systematic Reviews.” BMJ Open, British Medical Journal Publishing Group, 1 Dec. 2016, bmjopen.bmj.com/content/6/12/e013806.

“Morbidity and Mortality After Lifestyle Intervention for People With Impaired Glucose Tolerance.” PracticeUpdate, 2 May 2019, www.practiceupdate.com/c/82928/1/8/?elsca1=emc_enews_expert-insight&elsca2=email&elsca3=practiceupdate_diab&elsca4=diabetes&elsca5=newsletter&rid=OTE0MTIxOTE4NTkS1&lid=10332481.

Rowley, William R, et al. “Diabetes 2030: Insights from Yesterday, Today, and Future Trends.” Population Health Management, Mary Ann Liebert, Inc., 1 Feb. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5278808/.

 

Maya Rudolph, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate