Type 2 lifestyle fixes show staying power

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By  Published  December 1, 2006

Lifestyle intervention in type 2 diabetes can stave off the disease even in the longer-term, according to new results from a Finnish study. Three years after cessation of active counselling, study participants had maintained beneficial lifestyle changes and, as a result, the relative risk of diabetes versus controls decreased 36% during this period. The results were published in the Lancet. The findings came from an extended follow-up of 522 patients in the Finnish Diabetes Prevention Study. The study included 172 overweight, middle-age men and 350 women from five centers. All participants had impaired glucose tolerance and were randomly assigned to intensive lifestyle intervention or a control group. After four years of active intervention, participants who were still free of diabetes were further studied for three years, with a total follow-up of seven years. The main goals of the intervention were: weight reduction of 5% or more, less than 30% of the daily energy intake from fat, less than 10% from saturated fat, fiber intake 15 g/1,000 kcal or more, and moderately intense physical activity of 30 minutes a day or more. Participants in the intervention group were given detailed and individualised counselling to achieve these goals, plus seven personal counselling sessions with the study nutritionist during the first year and every three months afterward. The participants were also offered supervised moderate-intensity resistance training. Members of the control group were given general verbal and written health behavioural information at baseline without individualised advice. During the total seven-year follow-up, the incidence of type 2 diabetes was 4.3 and 7.4 per 100 person-years in the intervention and control group respectively, indicating a 43% reduction in relative risk. The risk reduction was related to the success in achieving the established intervention goal, the researchers said. In a subgroup analysis, there was also a marked improvement in insulin sensitivity along with weight loss, whereas insulin secretion did not change significantly. This finding suggests that the prolonged benefit of the lifestyle intervention could be attributed partly to a correction of insulin resistance, which, on the other hand, might result in a preservation of the beta cell function, the researchers said. Future studies, the researchers said, will reveal whether the results from this trial can be transposed into a usual health-care setting. The high diabetes rate even in the intervention group suggests that preventive action should probably be targeted to all high-risk individuals, even before impaired glucose tolerance is present, they said. Future research is needed to reveal the optimum and most cost-efficient strategy, intensity, and duration of such an intervention.

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