A large randomized
trial in which individuals with pre-diabetes lost weight, improved their diet
quality, and maintained regular physical activity illustrates just how remarkably
effective lifestyle change is in preventing pre-diabetes from progressing to
diabetes.
In the first phase
of the intervention, individuals with pre-diabetes adopted an 800-daily calorie
liquid meal replacement diet for two months. Participants lost a minimum of 8%
bodyweight. Following the initial period
of weight loss, participants were assigned to one of four treatment groups in
which subjects were instructed to increase physical activity to either 75
minutes of high-intensity exercise or 150 minutes of moderate-intensity
exercise weekly and to follow either a high protein/low-glycemic index diet or
a moderate-protein/moderate-glycemic index diet. A low glycemic index diet minimizes intake of
quickly digested carbohydrates such as those in sweets, refined grains, and
some starchy vegetables, and instead focuses on slowly digested whole food
sources of carbohydrates such as non-starchy vegetables, most fruits, whole
in-tact grains, and beans. Participants
were also provided sustained nutritional and physical activity counseling. In the study, after 3 years, of the 962
pre-diabetic patients still participating in the study, only 6% had progressed from
pre-diabetes to type 2 diabetes. There
was no significant difference between the two dietary treatments nor the
activity treatments. These results
highlight the fact that the vast majority of those with pre-diabetes can
prevent diabetes if they maintain modest weight loss, make healthier dietary
choices, and do regular activity.
Unfortunately,
this study also illustrates that even when individuals’ are provided with a lot
of support in adopting and maintaining lifestyle changes, many do not stick with
these changes over the long-term. Only about 1.5% of participants did not achieve
the initial 8% weight loss cut-off while on the full meal replacement diet but
nearly half of study participants did not finish the weight loss maintenance arm of
the study. Thus, the intervention
was very effective but only if adhered to, and therein lies the tremendous challenge of behavioral change.
What
to do: For most individuals, an effective strategy to prevent pre-diabetes from becoming diabetes is to lose a fair amount of weight and then keep the weight off while maintaining regular physical activity. What can you do to
increase your odds of weight loss maintenance?
Lost weight must be proactively defended. Frequent self-monitoring (such
as journaling intake, regularly checking weight), integrating food preparation
and activity into the fabric of your daily and weekly routines (such as an active commute, structured menu planning, batch cooking & freezing healthy meals),
enlisting social support, doing at least 1 hour of regular physical activity
daily, eating slowly and mindfully, and utilizing healthy non-food coping
techniques are some of the strategies most associated weight loss maintenance. Also,
where medically indicated, bariatric surgery, while no guarantee, significantly
increases one’s odds of maintaining substantial weight loss and reversing
pre-diabetes.
Information adapted from articles
available at: https://www.healio.com/endocrinology/diabetes/news/online/%7B996c7f17-b77c-4518-9270-090d2ea074dc%7D/preview-intensive-weight-loss-behavior-change-prevents-conversion-to-type-2-diabetes
Source:
Macdonald I. Prevention of diabetes
through lifestyle intervention — results from the multicenter PREVIEW study.
Presented at: American Diabetes Association 79th Scientific Sessions; June
7-11, 2019; San Francisco.
