[acb-diabetics] lif style over and above ...

Thu Sep 9 23:51:22 GMT 2010

This article originally posted 

02 September, 2010

 and appeared in  

Type 2 Diabetes, 

Issue 537

Lifestyle Over and Above Drugs in Diabetes Study

Intensive dietary advice has the potential to appreciably improve glycemic
control and anthropometric measures in patients with Type 2 diabetes who are

hyperglycemic despite optimized drug treatment. 

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The study was done to determine the extent to which intensive dietary
intervention can influence glycemic control and risk factors for
cardiovascular disease

in patients with Type 2 diabetes who are hyperglycemic despite optimized
drug treatment. 

The study was a randomized controlled trial with 93 participants aged less
than 70 years with Type 2 diabetes and an A1c of more than 7% despite
optimized

drug treatments plus at least two of the following conditions; overweight or
obesity, hypertension, and dyslipidemia. 

The intervention was intensive individualized dietary advice (according to
the nutritional recommendations of the European Association for the Study of

Diabetes) for six months: both the intervention and control participants
continued with their usual medical surveillance. 

The main outcome measures were the A1c results and the secondary outcome
measures included measures of adiposity, blood pressure, and lipid profile. 

After adjustment for age, sex, and baseline measurements, the difference in
A1c between the intervention and control groups at six months (-0.4%, 95%
confidence

interval -0.7% to -0.1%) was highly statistically significant (P=0.007).

After six months, levels of A1c in the intervention group declined from a
mean of 8.9% to 8.4% but remained unchanged at 8.6% in the control group.
Significant

differences (favorable to the intervention group) were also observed in
weight, body mass index, and waist circumference. Moreover, in 29% of the
control

group, prescribed doses of diabetes drugs were increased compared with 9% of
the intervention group. However, doses of diabetes drugs were reduced in 13%

of the intervention group compared with 4% of the control group. The main
change in diet was a reduction in intake of saturated fatty acid by the
intervention

group (

P

 = 0.006).

>From the results it was concluded that intensive dietary advice has the
potential to appreciably improve glycemic control and anthropometric
measures in

patients with Type 2 diabetes and unsatisfactory A1c results, despite
optimized drug treatment. 

Lifestyle modification is the recommended first-line therapy for glucose
management and is supposed to be continued as treatment intensification
almost

invariably becomes necessary. Before the study by Coppell and associates,
however, the benefits of intensive lifestyle intervention applied at later
stages

of diabetes therapy had not been investigated. Although relatively modest,
the reduction in A1c levels (as well as weight and waist reductions)
occurred

after only six months of dietary changes. Of course, these benefits are
notoriously short-lived. Whether further reductions would occur with ongoing
intervention

or the reductions could be maintained after cessation of the intervention
remains to be seen. However, a recent study found that A1c levels remained
lower

among newly diagnosed patients who initially lost weight (compared with
those who gained weight ) even after the weight was regained, and diabetes
prevention

studies have found long-term benefits in lifestyle modification well after
the interventions ended.

 In light of these findings, the current study suggests that lifestyle
modification may be beneficial regardless of when it is initiated. 

 (ISSN: 1468-5833)  

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The study was done to determine the extent to which intensive dietary
intervention can influence glycemic control and risk factors for
cardiovascular disease