Healthy lifestyle key to halting diabetes

People hoping to slow down or halt the development of diabetes should focus on their lifestyle rather than relying on drugs to do the job for them, a major new study has found.

According to the findings, moderate exercise, weight control and other lifestyle changes appear to play an essential role in reducing the risk of diabetes among those at high risk.

The large-scale trial looked at the effectiveness of two treatments in people who already had impaired glucose tolerance, a condition which can go on to become diabetes. The participants were also either at risk of, or they already had, established heart disease.

One of the drugs used in the trial, nateglinide (Starlix), is an anti-diabetes medication that minimises spikes in blood sugar after meals. Researchers had thought that it would reduce progression to diabetes by restoring a more normal insulin response after meals. In addition, it was hoped the drug would also reduce the risk of cardiovascular disease.

The other drug, valsartan (Diovan), is used to treat high blood pressure, heart failure and the long-term consequences of a heart attack. Some studies have suggested that this class of drugs may also delay or prevent the development of diabetes.

The trial involved over 9,300 patients living in 40 countries worldwide. Each received one of the drugs or a placebo. All participants also received a lifestyle modification program aimed at reducing body weight and dietary fat intake while increasing physical activity. They were then followed up for around five years.

The UK and US researchers found that valsartan led to a 14% reduction in the development of type 2 diabetes – that is 38 fewer cases of diabetes per 1,000 participants treated for 5 years. However it did not reduce the number of cardiovascular events.

The study also showed that nateglinide was ineffective in halting progression to diabetes and had no impact on reducing cardiovascular events.

In other words, valsartan modestly reduced progression to diabetes in the patients but had no effect on cardiovascular health, while nateglinide had no effect on either the development of diabetes or heart problems.

According to the researchers, ‘lifestyle modification remains the best choice for preventing diabetes in high-risk patients’.

“Eating a healthy diet, exercising regularly and maintaining a normal body weight are critical for long-term health in patients at risk for diabetes and vascular disease,” said co-chair of the trial, Prof Rury Holman of the Oxford Centre for Diabetes, Endocrinology and Metabolism at the University of Oxford.

However, while only a modest benefit was seen for one of the drugs, and no effect on heart disease was recorded for either drug, the researchers said that the trial reinforces the need to apply the known benefits of changing lifestyle for the better and to continue the search for successful and safe medications.

“This is a sobering confirmation of the need to continue to focus on lifestyle improvements while also accelerating the efforts to develop new treatments for the exploding epidemics of diabetes and cardiovascular disease around the world,” said co-chair, Prof Robert Califf of the Duke University School of Medicine in the US.

Details of these findings are published by the New England Journal of Medicine.

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[Posted: Mon 15/03/2010]