Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
TL;DR: In this paper, the authors compared a lifestyle intervention with metformin to prevent or delay the development of Type 2 diabetes in nondiabetic individuals. And they found that the lifestyle intervention was significantly more effective than the medication.
Abstract: Background Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors — elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle — are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. Methods We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. Results The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. Conclusions Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
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09 Oct 2019
TL;DR: Systematic Review | Volume 6 | Number 1| 1 Copyright 2019 by Kaur KK.
Abstract: Systematic Review | Volume 6 | Number 1| 1 Copyright 2019 by Kaur KK. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited. cc Article information Received: February 2nd, 2019; Revised: March 13th, 2019; Accepted: March 14th, 2019; Published: March 22nd, 2019 Kulvinder Kochar Kaur, MD1*; Gautam Allahbadia, MD, DNB2; Mandeep Singh, MD, DM3
8 citations
TL;DR: The results highlight the need for multiple lifestyle behavioral interventions to maintain and improve HRQoL in the elderly individuals with prediabetes in rural areas.
8 citations
12 Sep 2011
TL;DR: The main health promotion intervention here is the public health education which highlights the importance of physical activity for the prevention of type 2 diabetes in the population of Pakistan.
Abstract: The incidence of type 2 diabetes is increasing worldwide, resulting in large measure from the increasing prevalence of obesity (Yale, 2000). Diabetes mellitus is a pandemic disease and is one of the main threats to human health (Narayan, 2005). In 2003, 194 million people worldwide, ranging in age from 20 to 79 years, had diabetes. It is projected that this number will be increased by 72% to 333 million by 2025, and nearly 80% of these cases will be in the poorer industrialized countries (IDF, 2003). According to a 2005 US Government estimate, approximately 21 million people in the United States have diabetes (Gerich, 2005). In 2002, diabetes was the sixth leading cause of death and had an estimated total cost of $132 billion (Hogan et al. 2003). Type 2 diabetes is a disease characterized by a dual defect: 1) by insulin resistance which prevents cells from using insulin properly, and 2) degrees of reduced pancreatic insulin secretion. In the local context, according to World Health Organisation (WHO, 2004), prevalence of Type 2 diabetes in Pakistan for the year 2000 was 5.2 million and for 2030 it would be around 13.8 million. A quarter of the population of Pakistan would be classified as overweight or obese with the use of Indo-Asian-specific BMI cutoff values. Jafar et al (2006) have reported that prevalence of overweight was 25% and obesity was 10% in a large population-based sample of people over the age of 15 years in Pakistan. On the age-specific prevalence of overweight and obesity, they found that more than 40% of women and 30% of men aged 35–54 years were classified as overweight or obese. It has been suggested in a variety of observational and epidemiological studies that physical activity may play a significant role in the prevention of type 2 diabetes mellitus. The relationships between physical activity and overweight are only beginning to be understood for the adult population, sedentary behaviours, particularly watching television (TV) and videos, surfing the internet have been found to be related to higher body mass index (BMI) for adult’s population (Struber, 2004). The literature linking physical activity levels with risk of overweight in adults is not consistent but physical activity is an important component of effective obesity treatments (Saelens, 2003). The main health promotion intervention here is the public health education which highlights the importance of physical activity for the prevention of type 2 diabetes in the
8 citations
TL;DR: The authors' preliminary data prove that a 3-week programme determined a clinically significant multi-dimensional improvement in patients with severe obesity, and psychometric assessment showed improvements in quality of life perception and binge eating disorder.
Abstract: To analyse the short-term effectiveness of an intensive multidimensional inpatient programme specifically developed for patients with severe obesity. A multidisciplinary team managed a 3-week residential programme characterised by the integration of nutritional and physical rehabilitation with psychological and educational intervention. All patients consecutively admitted in 10 months were analysed at admission and discharge for changes in the following domains: anthropometry (weight, body mass index (BMI), waist and neck circumferences), cardiovascular risk factors (glycaemia, HbA1c, lipid profile, blood pressure), quality of life, eating behaviour, and physical performance (VO2peak by incremental cycle ergometer test, 6-min walking test (6MWT), chair stands test). 136 subjects (61% females, median age 52.7 years) with obesity (mean BMI 43.2 kg/m2) and multiple comorbidities were analysed. A 3.9% BMI reduction and a reduction in waist (−3.8%) and neck (−3.3%) circumferences were observed. Glycaemic control was achieved in 68% of patients with uncontrolled diabetes at admission. Blood pressure control was achieved in all patients with uncontrolled hypertension at admission. Total cholesterol (−16%), LDL-cholesterol (−19%) and triglycerides (−9%) were significantly reduced. Psychometric assessment showed improvements in quality of life perception and binge eating disorder. Finally, a significant improvement in physical performance (+4.7% improvement in VO2peak, with longer distances in 6MWT and a higher number of standings) was observed. Our preliminary data prove that a 3-week programme determined a clinically significant multi-dimensional improvement in patients with severe obesity. Long-term follow-up data are needed to confirm the efficacy of our rehabilitation setting.
8 citations
TL;DR: The problems in current CHD risk management are highlighted, the updated evidence base within clinical recommendations to effectively manage at-risk patients are summarised and primary care physicians are best placed to instigate adherence-enhancing strategies, which may ultimately reduce mortality and morbidity.
Abstract: The identification of modifiable risk factors for coronary heart disease (CHD) and therapies for their management has led to the development of many national and international guidelines. However, despite the general acceptance and use of such guidelines, CHD, the principal manifestation of cardiovascular disease (CVD), remains the leading cause of mortality worldwide, with dyslipidaemia one of the most important modifiable risk factors. Many patients remain unidentified and untreated or, if receiving treatment, do not reach guideline targets. All guidelines recommend screening strategies for identifying at-risk patients and assessment. Lifestyle changes are the basis of any treatment strategy, with patients often requiring behavioural counselling. Those unable to achieve or maintain adequate risk reduction on lifestyle changes alone, and high-risk patients, also require pharmacotherapy. Reducing low-density lipoprotein cholesterol (LDL-C) remains an important goal of pharmacotherapy, although some patients, particularly those with diabetes, may need to reduce triglycerides and increase high-density lipoprotein cholesterol. Statins are the first-choice agents for LDL-C reduction. However, optimal dosage is important. Many patients fail to adhere to therapy, and primary care physicians are best placed to instigate adherence-enhancing strategies, which may ultimately reduce mortality and morbidity. This clinical review highlights the problems in current CHD risk management and summarises the updated evidence base within clinical recommendations to effectively manage at-risk patients.
8 citations
References
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Journal Article•
TL;DR: In this article, the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a randomised controlled trial were compared.
17,108 citations
TL;DR: It was deemed essential to develop an appropriate, uniform terminology and a functional, working classification of diabetes that reflects the current knowledge about the disease.
Abstract: the growth of knowledge regarding the etiology and pathogenesis of diabetes has led many individuals and groups in the diabetes community to express the need for a revision of the nomenclature, diagnostic criteria, and classification of diabetes. As a consequence, it was deemed essential to develop an appropriate, uniform terminology and a functional, working classification of diabetes that reflects the current knowledge about the disease. (1)
11,886 citations
TL;DR: Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects by means of individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity.
Abstract: Background Type 2 diabetes mellitus is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known. Methods We randomly assigned 522 middle-aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean body-mass index [weight in kilograms divided by the square of the height in meters], 31) with impaired glucose tolerance to either the intervention group or the control group. Each subject in the intervention group received individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity. An oral glucose-tolerance test was performed annually; the diagnosis of diabetes was confirmed by a second test. The mean duration of follow-up was 3.2 years. Results The mean (±SD) amount of weight lost between base line and the end of ye...
10,178 citations
Journal Article•
TL;DR: The effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a randomised controlled trial were compared.
8,546 citations
Journal Article•
TL;DR: Since intensive glucose control with metformin appears to decrease the risk of diabetes-related endpoints in overweight diabetic patients, and is associated with less weight gain and fewer hypoglycaemic attacks than are insulin and sulphonylureas, it may be the first-line pharmacological therapy of choice in these patients.
7,395 citations