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Health Guidelines

Preventing Diabetes Type 2 -- Which Works Best, Medication or Lifestyle?

Diabetes -- Quick Facts

17 million people have diabetes

1/3 of these people are unaware they have diabetes

Another 16 million people have prediabetes.

People with diabetes are up to 4 times more likely to develop heart disease than those without diabetes.

73% of adults with diabetes develop elevated blood pressure

Who should be tested for diabetes? Persons 45 years or older; sooner if you have risk factors:

Overweight
High blood pressure
High triglycerides
Low HDL cholesterol
Family history of diabetes
Gave birth to a baby weighing 9 lb or more
History of gestat-ional diabetes
Certain ethnic groups who are higher risk: Hispanic, Native American, Pacific Islander

Diabetes can be prevented, or at least delayed, by:

Regular exercise, 30+ min. 5+ days per week
Losing excess body fat
Eating healthfully:
- eat more dietary fiber
- limit refined carbohydrates (especially high glycemic index foods)
- choose healthy fats (veg. oils) in place of solid fats or trans fats
- drink milk instead of soda pop at meals
Not smoking
Taking certain medications if indicated by your doctor (such as metformin)

About 8% of adults in the United States (17 million) have diabetes. Another 16 million persons have "prediabetes" defined as above normal blood sugar levels (110-125 mg/dL) but not high enough to be diagnosed as diabetic yet.¹

Treatment is available for diabetes but health risks still remain very high for serious complications including blindness, kidney disease, amputation of feet and legs, heart disease, and early death. One large population study showed a decrease in life expectance of 4.2 years in men and 7 years in women.²

The best approach is to prevent the development of diabetes if possible. The Diabetes Prevention Program Research Group conducted a large, randomized clinical trial of persons who were high risk for diabetes to test the possibility of prevention. They also wanted to test which was more effective, medications or a change in lifestyle.

The study included 3234 people who were high risk for adult onset diabetes (type 2). They were overweight (average BMI of 34) and had high fasting blood glucose levels (95-125 mg/dL) but not high enough to be diagnosed with diabetes (average glycosylated hemoglobin levels of 5.9%, less than 5 is ideal).

These people were randomly assigned to 3 groups for follow-up:

Placebo group -- took a pill daily but didn't know what it was they were taking. They also were given information on a healthy lifestyle
Medication group -- took a pill (metformin) that helps improve insulin resistance thus decreasing risk of diabetes
Lifestyle intervention group -- participants were not given any medication but were encouraged to do two things: lose weight, at least 7% of their current weight, and to exercise 150 minutes per week, primarily walking. Each participant was given weekly health counseling for 16 weeks and then monthly follow-up support education.

Here is what was found after 3 years of follow-up. Half of the lifestyle intervention group reached their weight loss goal (7% of their weight) and 74% reached their exercise goal (150 minutes per week). The incidence of diabetes was 58% lower in the lifestyle intervention group and 31% lower in the medication group than the placebo group.

Both approaches showed a significant improvement compared to the placebo group, but the lifestyle intervention was about twice as effective and without the side effects of the medication. Keep in mind that only half the people in the lifestyle intervention group reached their weight loss goal. If they had all achieved their weight loss and exercise goals the result would have been even higher.

This is very encouraging news. Diabetes can be largely prevented (reduced by 58%) or delayed, even in people who are already at high risk or borderline diabetics.

Resources

Download and view MS PP slides (6) on Diabetes Prevention

References

1. American Diabetes Association, Fact Sheet, from ADA web site, accessed April 24, 2002
2. Diabetes Prevention Program Research Group, Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin, New England Journal of Medicine 346(6):393-403, Feb. 7, 2002

Making Healthy Choices articles are written by Don Hall, DrPH, CHES president of LifeLong Health with contributions from associated health professionals. Content is general health information from evidence based research. It's purpose is not to treat disease or take the place of advice by your doctor but to promote healthy lifestyles. Persons with health problems should contact their physician for specific guidance.