Intensive Lifestyle Changes Keep Type 2 Diabetes at Bay
TUESDAY, Dec. 18 -- An intensive lifestyle intervention program that includes weight loss and increased exercise can bring about a remission of type 2 diabetes in people who have had the disease for several years. The catch? Less than 2 percent of the people who tried it were able to achieve a complete remission, and if they don't maintain the changes, it's likely that their diabetes will quickly return.
The lifestyle intervention, however, was able to significantly improve the health of more than 10 percent of those who followed it, inducing partial remission of type 2 diabetes, weight loss, greater fitness levels and a reduced need for medication for high blood pressure.
"Whether it's preventing type 2 diabetes or preventing its complications, a healthy diet and an active lifestyle can make a difference," said study lead author Edward Gregg, chief of the epidemiology and statistics branch in the division of diabetes translation at the U.S. Centers for Disease Control and Prevention.
Although Gregg acknowledged it was difficult to achieve a complete remission of long-standing type 2 diabetes, the study also showed that it was possible. "These findings are encouraging given the common belief that once you have type 2 diabetes, unless you have obesity surgery, you can't change diabetes if you've had it for a while," he said.
Type 2 diabetes is a metabolic disorder associated with a genetic susceptibility to the disease, a sedentary lifestyle and obesity, according to the American Diabetes Association.
The current study, which was published in the Dec. 19 issue of the Journal of the American Medical Association, was a randomized controlled trial lasting four years. One group was assigned to receive the intensive lifestyle intervention program, while the other group received standard diabetes education and support.
The intensive lifestyle intervention program included weekly group and individual counseling sessions during the first six months, followed by three sessions per month for the next six months. Next were twice-monthly contact and regular group refresher campaigns in years two through four. Target weight and physical activity goals were set, along with daily caloric intake goals of between 1,200 and 1,800 calories. Liquid meal replacements were provided if requested.
About 1,850 participants in each group completed the study. They'd had diabetes for five years on average, and their average age was 59. There were slightly more female participants. The average body-mass index -- a measure of body fat based on height and weight -- was 36 for both groups, placing them well into the obese category.
Full remission of diabetes was defined as a transition from meeting a diabetes diagnosis to normal blood sugar levels -- a fasting level of less than 100 milligrams per deciliter (mg/dL) or a hemoglobin A1c (HbA1c) of less than 5.7 percent -- without diabetes medications.
A partial remission meant the transition from type 2 diabetes to a prediabetes state -- fasting blood sugar level of 100 to 126 mg/dL or an HbA1c of 5.7 percent to 6.5 percent.
Just 1.3 percent of those in the intensive lifestyle changes group were able to achieve a complete remission at the end of year one, while only 0.1 percent of those in the standard care group did. At year four, the complete remission rate was 0.7 percent for the intensive group compared with 0.2 percent for standard care at both times.
The intensive group achieved an 11.5 percent rate of any type of remission (full or partial) at year one and 7.3 percent at year four. The standard care group was only able to achieve a 2 percent remission rate.
The intensive lifestyle intervention did result in more weight loss and greater levels of fitness, as well as a need for less high blood pressure medication, according to the study.
Dr. Robert Ratner, chief scientific and medical officer for the American Diabetes Association, said the word "remission" suggests that once the lifestyle intervention is over, you can stop what you're doing and the disease would stay away. But, he said, the improvements come from the continued use of lifestyle interventions.
"The issue is one of definition, and whether or not you've reversed diabetes or are simply controlling it," Ratner said.
Rates of remission decreased as the intensive program wound down, and Ratner said that "suggests that lifestyle modifications aren't sufficient enough to control type 2 diabetes in the long term. Type 2 diabetes is a progressive disorder and, over time, we see further changes in biology that make it more difficult to control."
Ratner noted that lifestyle changes don't bring diabetes under control for everyone. "We emphasize the importance of lifestyle modifications in all forms of diabetes, but the fact that diabetes sometimes remains uncontrolled is biology, and not something that is the patient's fault," he said.
Still, both Ratner and Gregg said, spending extra years with good blood sugar control, as many of the participants in this study did, would likely help to prevent complications. Ratner said these programs tend to be cost effective when the reduction in diabetes complications, as well as improved overall health and a reduced need for other medications such as high blood pressure or high cholesterol drugs, are taken into account.
Learn more about type 2 diabetes from the American Diabetes Association.
Posted: December 2012
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