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Question #814

You are reviewing lifestyle modifications with a 42-year-old, relatively sedentary patient who has been newly diagnosed with prediabetes. Your screening for any cardiovascular risk factors was negative, so she has agreed to a 3-month trial of dietary modifications and increased physical activity. Structured exercise interventions and modest weight loss have been shown to lower the risk of developing type 2 diabetes in high-risk populations by an average of:

Correct

Answer:  C. 58%

The Da Qing study in China found even modest changes in exercise (20 minutes mild-moderate, 10 minutes strenuous, 5 minutes very strenuous exercise 1-2 times per day) reduced the risk of developing diabetes by 46%. The Finnish Diabetes Prevention Study and the U.S. Diabetes Prevention Program (DPP) looked at the effects of intensive lifestyle modifications (diet and increased physical activity) on the development of diabetes in individuals with either IGT or IFG. The Finnish study participants were assigned to either 30 minutes/day of moderate physical activity or a “no-change” group. The DPP participants were randomized to either control, metformin or lifestyle modifications (dietary changes, weight loss goals and 150 minutes of weekly aerobic activity) groups. The Finnish Diabetes Prevention Study and the U.S. Diabetes Prevention Program (DPP) both showed 58% reduction in diabetes incidence. Participants in the DPP metformin group had a 31% reduced incidence of developing diabetes. The benefits of increased physical activity on diabetes prevention endured across ethnic groups, both sexes and those who did not meet weight loss goals.

Reference(s):

  1. American Diabetes Association. Standards of medical care in Diabetes – 2013. Diabetes Care. January 2013; 36(Suppl. 1):S11-S66. Available at http://care.diabetesjournals.org/content/36/Supplement_1/S11.full. Accessed Jan. 11, 2013.
  2. Colberg SR, Sigal RJ, Fernhall B et al. Exercise and type 2 diabetes. The American College of Sports Medicine and American Diabetes Association: Joint Position Statement. Diabetes Care. 2010; 33:2692-2696.
  3. Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997; 20(4): 537–544.
  4. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344(18):1343–1350.
  5. Eriksson J, Lindstrom J, Valle T, et al. Prevention of type II diabetes in subjects with impaired glucose tolerance: The Diabetes Prevention Study (DPS) in Finland. Study design and 1-year interim report on the feasibility of the lifestyle intervention programme. Diabetologia 1999; 42(7):793– 801.
  6. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346(6):393– 403.
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