Practical Practitioner
By: Pamela Egan, FNP-C CDE
Type 2 Diabetes Prevention
For the first time, clinical research shows that reducing health risks through weight control, a balanced diet and physical activity is a cost-effective way to delay the development of Type 2 Diabetes.
Two studies published in the March 2005 issue of Annals of Internal Medicine are the first to demonstrate the value of lifestyle intervention among non-diabetic patients. Results from the Diabetes Prevention Program showed that lifestyle modification and metformin therapy can delay or prevent the development of Type 2 Diabetes.
The goal of the lifestyle intervention used by Diabetes Prevention Program was to achieve 150 minutes of physical activity per week and a 7 percent weight loss.
Lifestyle modifications included a healthy, low-fat low-calorie diet and moderate physical activity such as brisk walking.
Participants followed a 16-lesson core curriculum covering diet, exercise, and behavioral modification taught one-on-one by a case manager, supplemented by regular individual and group sessions.
Similar results were reported from the Multiple Risk Factor Intervention Trial. One of the largest randomized clinical trials of lifestyle intervention ever undertaken, MRFIT 12,866 men aged 35 to 57 who were followed for 6 to 7 years at 22 medical centers.
The intervention for participants with normal glucose levels included advice to reduce intake of saturated fats (animal fats) and increase intake of polyunsaturated fats (olive oil, avocados), to reduce weight if the participant was overweight or obese, and to increase physical activity.
Lifestyle intervention reduced the incidence of type 2 diabetes by 18 percent over a 6-year period among non-smokers.
Because it costs more up front and requires more time and attention to achieve lifestyle changes, risk reduction remains a hard sell among payers and clinicians alike.
Although insurance companies admit that lifestyle intervention works, their response is that it’s easier to write a prescription. Our health system pays for pharmacologic intervention, but generally not for lifestyle intervention.
The tide may be changing slowly, as studies like these provide further evidence that improving health makes economic sense. Large payers such as Medicare and managed-care plans are becoming more open to dietary intervention to reduce diabetes risk, along with other lifestyle modifications.
Clearly it’s important to stress the importance of a healthy lifestyle that includes good nutrition and exercise.
Initiating conversations about recent findings, including those of the Diabetes Prevention Program, helps to educate patients about the degree to which behavioral modification can help ward off ill health.
This article was originally published May 2, 2005 in The St. Tammany News.
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