Intensive lifestyle intervention is the new black
According to the Danish type 2 diabetes study, U-TURN, published in The Journal of the American Medical Association (JAMA) by Danish Diabetes Academy Post Doc fellow Mathias Ried-Larsen and his colleagues at Centre of Inflammation and Metabolism and Centre for Active Health, Rigshospitalet, a high amount and intensity of exercise along with a diet plan resulted in a modest reduction in blood glucose levels among adults with type 2 diabetes, but was accompanied by reductions in the use of glucose-lowering medications.
LIFESTYLE INTERVENTIONS ARE NEEDED
Although medication is effective in lowering hemoglobin A1c (HbA1c) in patients with type 2 diabetes, it is also associated with potential adverse drug interactions, discomforts, increased economic costs and decreased quality of life. Lifestyle interventions are needed that are able to maintain glycemic control to at least the same extent as medication.
Mathias Ried-Larsen and colleagues randomly assigned adults with non-insulin-dependent type 2 diabetes, who were diagnosed for less than 10 years to a standard care group (n = 34) or a lifestyle group (n = 64). All participants received standard care with individual counseling and standardized, target-driven medical therapy. The lifestyle intervention included five to six weekly aerobic training sessions (duration 30-60 minutes), of which two to three sessions were combined with resistance training. The lifestyle participants received dietary plans aiming for a body mass index of 25 or less. Participants were followed up for 12 months.
SURPRISINGLY A REDUCTION IN GLUCOSE-LOWERING MEDICATIONS OCCURED IN 73% OF PARTICIPANTS IN THE LIFESTYLE GROUP
From study entry to 12-month follow-up, the average HbA1c level changed from 6.65 percent to 6.34 percent in the lifestyle group and from 6.74 percent to 6.66 percent in the standard care group (average between-group difference in change of -0.26 percent), not meeting a prespecified criteria for equivalence between groups. Reduction in glucose-lowering medications occurred in 73.5 percent of participants in the lifestyle group and 26.4 percent of participants in the standard care group (difference, 47.1 percentage points).
The study notes some limitations, including that the self-reported dietary intake is subject to biases and limitations.
“Among adults with type 2 diabetes diagnosed for less than 10 years, a lifestyle intervention compared with standard care resulted in a change in glycemic control that did not reach the criterion for equivalence, but was in a direction consistent with benefit. Further research is needed to assess superiority, as well as generalizability and durability of findings”, the authors conclude.
FACTS ABOUT DIABETES
- According to the Danish Diabetes Association 290.000 Danes are diagnosed with type 2 diabetes and 750.000 have pre-diabetes.
- National Institute of Public Health estimates that the number of patients with type 2 diabetes will be doubled in 2030.
- According to the Danish Diabetes Association the costs for treating diabetes (type 1 and type 2) in Denmark amount to 86 million DKK per day.
CONTACT
Mathias Ried-Larsen, Group Manager, Trygfondens Centre for Active Health, Rigshospitalet and Danish Diabetes Academy
Tel.: 2178 2087
Email: Mathias.ried-larsen@regionh.dk
Mette Yun Johansen, PhD student, Trygfondens Centre for Active Health, Rigshospitalet
Tel.: 4073 5207
Email: Mette.yun.johansen@regionh.dk