WEIGHT LOSS & SUSTAINED LIFESTYLE CHANGE CAN PREVENT MOST TYPE 2 DIABETES

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

https://www.mdmag.com/conference-coverage/ada-2019/preview-data-diabetes-prevention-diet-exercise

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.