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Healthy Diet, Moderate Exercise Reduce Diabetes Risk Better Than Drugs

The study, published in this week's New England Journal of Medicine, presents the results of a large randomized trial conducted by the Diabetes Prevention Program Research Group between 1996 and 1999. The results were previously announced in a news conference given by Health and Human Services Secretary Tommy Thompson in November.

Researchers randomly assigned 3,234 nondiabetic people at high risk for developing diabetes to receive a placebo, the drug Glucophage or to participate in a lifestyle modification program. The goals of lifestyle modification included at least a 7 percent reduction in weight and at least 150 minutes of moderate intensity activity per week.

The groups were followed for an average of approximately three years to see which groups eventually developed diabetes.

The lifestyle intervention reduced the incidence of diabetes by 58 percent compared to the placebo. Glucophage also reduced diabetes incidence compared to the placebo, but only by 31 percent.

Drugs vs. Lifestyle

Many experts are encouraged by these findings and feel that they will have considerable impact for millions of people in the United States.

"This study is a big deal with considerable implications for public health and clinical practice," says Charles Clark, director of the Indiana University Diabetes Research and Training Center. "There are probably 12 million people who meet the criteria [of the study] and an equal number who are at somewhat less risk."

Type 2, or adult onset diabetes, is a metabolic disorder that results when the body cannot make enough or properly use insulin, a hormone that converts food to energy. This differs from type 1 diabetes, in which people must take daily insulin shots because their bodies don't produce any insulin, and is most commonly diagnosed in children and young adults. According to the American Diabetes Association, type 2 diabetes accounts for 90 to 95 percent of diabetes cases.

While lifestyle changes may be more difficult to make and adhere to than taking a pill, experts say that making the transition to a healthy diet and regular exercise is key.

"The important points of the study are that minimal changes in lifestyle are within the possibility of many different free-living individuals of different ethnicity and culture, and that it works better than medications," says Dr. Philip Orlander, professor and director of endocrinology at the University of Texas, Houston.

Even though Glucophage proved to have preventative benefits, Orlander feels it would be unfortunate if the take-away message was that, "pills are easier to take than exercising 20 minutes a day and are almost as good."

An Ounce of Prevention

These findings are also significant because experts say that preventing diabetes before it develops is less difficult than controlling the disease after onset.

"Currently only 15 percent of people with type 2 diabetes are controlled with diet and exercise alone," says Dr. Steven Edelman, professor of medicine in the Division of Diabetes and Metabolism at the University of California, San Diego, School of Medicine. "The main reason for this is that they are too far advanced in their natural history and multiple drugs/insulin are needed to control the diabetes, which is not easy."

Physicians say these findings will help them make recommendations for people who are at high risk for developing the disease.

"We need not wait for them to get diabetes and the complications of diabetes," Dr. David Nathan of Massachusetts General Hospital in Boston told ABCNEWS Medical Correspondent John McKenzie on World News Tonight. "We can do something earlier."

"The bottom line is that when interventions are introduced early in the natural history of diabetes, it is possible to make significant impact," says Edelman.

Reference Source 104


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