Diabetes Prevention through Lifestyle Change

In the field of Diabetology (the study of the diagnosis and treatment of diabetes), one of the most well known and most important papers was published by the Diabetes Prevention Program (DPP) group in 2002. Their findings appeared in the New England Journal of Medicine in an article entitled “Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin.” Though over 20 years old, the findings reported in that paper are still relevant and still inform medical practice today.

The DPP group studied the outcome of diabetes prevention measures in over 3,000 individuals with elevated blood glucose levels whose body-mass index (BMI) was in the overweight or obese range. These individuals were divided into three groups. The first group received a placebo. The second was treated with the prescription medication metformin. The third group was treated with a lifestyle modification program. The individuals in the study were followed, on average, for just under 3 years. The outcome measured was the incidence of diabetes in each of the groups.

The study found that the incidence of diabetes was reduced by 58% in the lifestyle modification group compared to the placebo group. The metformin group had a 31% reduction in diabetes incidence compared to placebo. Thus, both lifestyle modification and metformin reduced the incidence of diabetes, but lifestyle modification was more effective.

What did the lifestyle modification group do to achieve this success? Participants were taught 1-on-1 by case managers a comprehensive curriculum on diet, exercise, and behavior modification.  They had ongoing check-ins with the case manager. The diet taught was low calorie and low fat. The recommended exercise was moderate intensity, such as brisk walking, for 150 minutes per week. The goal was to loose 7% of total bodyweight. Follow up studies showed the benefit of lifestyle modification was long lasting, beyond the period of the initial study.

What about metformin? Metformin is among the most commonly prescribed drugs in the US today. It was first synthesized in the 1920s, entered into clinical use in Europe in the 1950s and was approved for use in the US by the FDA in 1994. Metformin decreases blood glucose by increasing insulin sensitivity and decreasing glucose production by the liver. In the DPP study, the metformin group was treated with 850mg twice daily. Metformin is still used for diabetes prevention today in certain cases.

The DPP study is significant in that it showed that diabetes could be prevented and that lifestyle modification was an effective means of doing so.  The specific aspects of the lifestyle intervention used in the DPP were effective though they should not be interpreted as the only form of lifestyle modification that may be of benefit. For example, the dietary approach can be modified to suit an individual’s unique circumstances and other health conditions. The exercise prescription can also be adjusted, for example by including strength training. However, as mentioned in last week’s post, lifestyle factors play a major role in supporting health and healing, and the DPP demonstrated the power of lifestyle change in combatting type 2 diabetes.

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