Diabetes Prevention: 7 Years of Success

Plenty of data show that an education in healthy living can help keep pre-diabetes from turning into full-blown diabetes.

Now, research is finding how long-lasting the benefits are if the education itself is top-notch.

Scientists from the National Public Health Institute in Finland and several of Finland’s universities randomly assigned 522 overweight middle-aged men and women, all with increased fasting blood sugars, or pre-diabetes, to either intensive lifestyle intervention or a control group.

The intervention group attended seven counseling sessions with a nutritionist the first year and then quarterly for the next three years. They learned how to shed weight and get blood sugar under control via regular exercise and an eating plan that cut total fat and saturated fat and increased daily intake of fruits, vegetables, whole grains, and beans, similar to the Pritikin Program.  They also worked out in a supervised, individually tailored resistance training program and were counseled on weaving 30 minutes of aerobic exercise into their daily lives, again, similar to the Pritikin Program.

The men and women in the control, or usual care, group received one short presentation in general recommendations for diet and exercise, the type of lifestyle education pre-diabetics have traditionally received.

For all 522 subjects, the scientists periodically measured diabetes incidence, body weight, physical activity levels, and dietary intakes of fat, saturated fat, and fiber.

After four years, the lifestyle education for the intervention group ended. Three years later, the scientists revisited and re-tested everyone in both groups and found that the people in the lifestyle group had maintained a 43% reduction in diabetes incidence compared to the people in the control group.*

Moreover, lead author Jaana Lindstrom and colleagues reported, the protection from diabetes was directly related “to the success in achieving the intervention goals of weight loss, reduced intake of total and saturated fat, increased intake of dietary fiber, and increased physical activity.”

In an accompanying editorial, Dr. Ronald Goldberg of the Diabetes Research Institute, University of Miami, noted that this new study is strong evidence that current standard approaches for pre-diabetic patients don’t work, but intensive lifestyle interventions do. And in the long-term, they’re cost-effective “given the deluge of diabetes that threatens to overtake us worldwide.”

Given this new evidence of the sustainability of lifestyle benefits, both Dr. Goldberg and the Finnish scientists argued for urgent widespread establishment of education-intensive diabetes prevention programs, including refresher classes.

* The Lancet, 2006; 368: 1673.

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