Pre-Diabetes Treatment: What Works Best?

Lifestyle changes are far more effective than drugs for preventing the Metabolic Syndrome, a cluster of problems that can lead to diabetes and cardiovascular disease, according to a large federally-funded study of 3,234 men and women.

Lead investigator Dr. Trevor Orchard at the University of Pittsburgh and colleagues called the effects of lifestyle change “dramatic.”

Diabetes Prevention Program

At the beginning of the study, named the Diabetes Prevention Program, none of the subjects had type 2 diabetes, but they were on their way. All were struggling with high blood sugar, and more than half were diagnosed with the Metabolic Syndrome, which means they had three of more of the following five problems: abdominal obesity, high triglycerides, low HDL good cholesterol, high blood pressure, and elevated fasting blood sugar.

The scientists randomly divided the 3,234 pre-diabetics into three different groups. The first group was given the anti-diabetes drug metformin (brand name is Glucophage). The second received a placebo.

For pre-diabetes treatment, the third group received intensive lifestyle intervention – 16 educational workshops plus several refresher sessions, all centered on “losing weight through physical activity and a healthy low-calorie, low-fat diet,” wrote the authors.

Healthful Carbohydrates, Low In Fat

The lifestyle group was taught to be a “fat detective” and steer away from high-calorie/high-fat foods. The optimal diet, the workshops emphasized, was one rich in healthful carbohydrates like vegetables, fruits, and fiber-rich whole grains, supplemented with modest servings of lean protein like nonfat dairy foods and lean meat, much like the Pritikin Program.

Class titles included: “Move Those Muscles,” “Vegetarian Food Options,” “Healthy Eating On the Town,” “Healthful, Low-Fat Cooking,” “Managing Binges,” and “Staying Motivated.” (Yes, the education closely resembled the education received at the Pritikin Longevity Center.)

The two key goals of the lifestyle intervention approach were: 1) Maintain a weight reduction of at least 7%, and 2) Engage in physical activity of moderate activity, such as brisk walking, for at least 2 ½ hours a week.

Lifestyle More Than Twice As Effective As Drugs

At the three-year follow-up, the incidence of Metabolic Syndrome was reduced by 41% in the lifestyle group and by 17% in the metformin group compared with the placebo group. Healthy diet and regular exercise, in short, were nearly 2½ times more effective than medication at getting rid of the Metabolic Syndrome.

These data, concluded Dr. Orchard and his team, demonstrate the “dramatic effect of lifestyle … The beneficial effect of lifestyle intervention on components other than glucose level is particularly encouraging and provides important evidence of the value of this approach to those with blood pressure, weight, and lipid disturbances in general.”

The inferior effect of medication, the authors continued, “underscores the preferential value of lifestyle as the initial approach to prevention of the Metabolic Syndrome and its cardiovascular complications.”

Preventing Type 2 Diabetes

These conclusions are in line with an earlier study on the 3,234 men and women of the Diabetes Prevention Program, which found that lifestyle intervention did a better job than drugs at preventing type 2 diabetes.

Within three years, 29% of the subjects in the placebo group and 22% in the metformin group had developed diabetes. Among the healthy eaters and exercisers, just 14% had become diabetics.

Getting Rid Of Medications

With proper dietary intervention and regular exercise, blood sugar levels fall so dramatically, studies on the Pritikin Program have found, that many type 2 diabetics no longer require diabetes medications. In a meta-analysis of 284 diabetics who attended the Pritikin Longevity Center, 74% left Pritikin no longer needing drugs to control their blood sugar.

Concluded lead investigator Dr. James Barnard of UCLA School of Physiological Science, “If you’re in the early stages of type 2 diabetes, there every reason to believe you can live a healthy, productive free of diabetes by following a nutrition and exercise plan like the Pritikin Program.”


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