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fgummett
05-23-2008, 06:21 AM
CTV.ca | Diet, exercise reduce diabetes risk over long term (http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080522/diabetes_exercise_080522/20080522?hub=Health)

Updated Thu. May. 22 2008 5:18 PM ET

CTV.ca News Staff

If people at a high risk for diabetes spend six years following an improved diet and exercise regimen, they can reduce their risk of developing the disease for up to 14 years, a new study says.

The study, conducted by Chinese and American researchers, was published Thursday in a special diabetes edition of the journal The Lancet.

The researchers analyzed data from almost 800 Chinese adults with impaired glucose tolerance, a pre-diabetes condition whereby blood sugar levels are higher then normal. This happens when the body does not produce enough insulin, or does not properly use insulin, which carries glucose into the body's cells to be used as energy.

Researchers began to follow the patients in 1986 by assigning them to one of three intervention groups. They were put on a diet program, an exercise program, or a regimen of both, which lasted until 1992.

When researchers followed up with the patients in 2006, they found that the combined diet and exercise program reduced the incidence of diabetes by 51 per cent during the six-year intervention period, compared to a control group. Over the entire 20-year span of the study, the diet and exercise regimen reduced the incidence of diabetes by 43 per cent.

While it is well known that a healthy lifestyle can reduce risk factors for a variety of health problems, including diabetes, this study shows that improved diet and exercise habits can stave off diabetes over a long-term period.

"This study has shown that, in Chinese people with impaired glucose tolerance, group-based interventions targeting lifestyle changes such as diet and exercise produce a durable and long-lasting reduction in incidence of type 2 diabetes," the authors concluded in their study.

"Since around three million excess deaths a year are attributable to diabetes worldwide, lifestyle interventions seem to be a justifiable public-health action both in developed and developing nations."

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Abstract:
The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study

Background: Intensive lifestyle interventions can reduce the incidence of type 2 diabetes in people with impaired glucose tolerance, but how long these benefits extend beyond the period of active intervention, and whether such interventions reduce the risk of cardiovascular disease (CVD) and mortality, is unclear. We aimed to assess whether intensive lifestyle interventions have a long-term effect on the risk of diabetes, diabetes related macrovascular and microvascular complications, and mortality.

Methods: In 1986, 577 adults with impaired glucose tolerance from 33 clinics in China were randomly assigned to either the control group or to one of three lifestyle intervention groups (diet, exercise, or diet plus exercise). Active intervention took place over 6 years until 1992. In 2006, study participants were followed-up to assess the long term effect of the interventions. The primary outcomes were diabetes incidence, CVD incidence and mortality, and all-cause mortality.

Findings: Compared with control participants, those in the combined lifestyle intervention groups had a 51% lower incidence of diabetes (hazard rate ratio [HRR] 0∙49; 95% CI 0∙33−0∙73) during the active intervention period and a 43% lower incidence (0∙57; 0∙41−0∙81) over the 20 year period, controlled for age and clustering by clinic. The average annual incidence of diabetes was 7% for intervention participants versus 11% in control participants, with 20-year cumulative incidence of 80% in the intervention groups and 93% in the control group. Participants in the intervention group spent an average of 3-6 fewer years with diabetes than those in the control group. There was no significant difference between the intervention and control groups in the rate of first CVD events (HRR 0∙98; 95% CI 0∙71−1∙37), CVD mortality (0∙83; 0∙48−1∙40), and all-cause mortality (0∙96; 0∙65−1∙41), but our study had limited statistical power to detect differences for these outcomes.

Interpretation: Group-based lifestyle interventions over 6 years can prevent or delay diabetes for up to 14 years after the active intervention. However, whether lifestyle intervention also leads to reduced CVD and mortality remains unclear.

Ronin
05-23-2008, 01:34 PM
Hi Frank!

It seems that, from time-to-time somebody "proves" that diet and exercise and prevent/delay the onset of diabetes. The unfortunate part is that the news articles wind up wrapping the garbage and the scholarly reports wind up on a shelf somewhere while just about everyone goes on about their lives with no regard to the human body's needs for activity and reasonable nutrition.

sandmcd
05-25-2008, 04:43 PM
I am off meds....dieting and exercising. I have lost 15 pounds..now 5'7" at 148. I won't be testing until end of June. I am NOT testing myself at all. I may be stubborn, but I cannot become addicted to a test everytime I eat something.

Ronin
05-25-2008, 05:50 PM
Hi Sandmdc!

I have to ask the question: "How tall were you before you started diet and exercise?"

I am seriously concerned about your position that testing is equivalent to becoming "addicted." Testing is not an addiction, it is a form of measurement to know what your body does. Yes, it is bothersome, and involves an expense, but it is also the only way to "know" what your body is actually doing in reaction to your diet and exercise regimen.

By the same token, do not obsess on testing. I started out, like many others, doing a lot of testing and driving myself crazy. But, I did learn what did and did not work for me. Over time I reduced the amount of testing I do because I know how my body reacts to certain foods and types of exercise. I have also developed a "feel" for my BG levels, confirmed by testing.

Not testing at all is your choice, but if your results at your next planned test are good or bad will be probematic because you cannot pinpoint what you did right or wrong and be able to correct. Frankly, if your BG levels are too high, you can also sustain damage and not even know it.

BriOnH
05-25-2008, 08:50 PM
It's a 20 year old study in the making which is cool, but didn't we already know this?

Have any of you seen the biggest looser where a lot of the contestants each season have prediabetes and by the time they finish the program they are no longer diabetic?

I am not a type 2 diabetic expert, but in 80% of type 2 diabetics isn't weight, lack of diet, and exercise which triggers the expression of the type 2 diabetic gene?

99% of Type 1 diabetics carry the antibody that destroys pancreatic beta cells [Dr. Denise Faustman's findings] and it is believed that certain illnesses trigger this gene to be expressed. If some Type 1' never develop a/the illness which triggers the faulty antibody can they go there whole live never having Type 1 diabetes? Which then begs the question if Type 2 diabetics watch their weight, eat a proper diet, and exercise can they too go their whole lives never expressing the Type 2 gene?

BlueSky
05-25-2008, 09:04 PM
... Which then begs the question if Type 2 diabetics watch their weight, eat a proper diet, and exercise can they too go their whole lives never expressing the Type 2 gene?
Sounds reasonable, but If that was the case, how would you explain T2 diabetics who are thin, active and eat well?

BriOnH
05-25-2008, 09:08 PM
Sounds reasonable, but If that was the case, how would you explain T2 diabetics who are thin, active and eat well?

That's the other 20%.

sandmcd
05-26-2008, 07:01 AM
I am and always have been 5'7". WHY??

Ronin
05-26-2008, 04:58 PM
Everyone:

The topic always seems to drift into the question about the veracity of the diagnosis called "Pre-Diabetic."

From my perspective, the people who advocate for the diagnosis, are in what I call the "Environmental Camp." That is to say that they firmly believe that diabetes can be caused by your environment (i.e., what you eat, lack of exercise, all the things that you can/should control yourself).

If this position is accurate then people diagnosed as Pre-Diabetic should, though altering their lives, be able to bypass the onset of diabetes.

On the other side of the argument are the "Genetisists" who claim that it isn't what you eat or do, but that your genetics have a flaw that will inevitably lead to the onset of diabetes.

The reality of living as one with the diagnosis of Pre-Diabetic is that, without medication, I maintain BG statistics that are considered good-to-great for a full blown diabetic, while not quite as good as a person who is not at all diabetic. In short, modification of life-style would seem to have offset the onset of actual diabetes where medication would be required.

As to the active and lean folks who are diagnosed as Type-2's -- this is curious because I personally know more than a few of them (all fellow bicyclists). Type-2 treatments seem to work for a while but never resolve in the way that these medications work on an overweight inactive Type-2. The people I know have all been put on insulin after discovering that their C-Peptide readings were very low to almost non-existent. So, are they really Type-2, or was it a mis-diagnosis because the MD in question has the firm belief that any adult onset of diabetic symptoms is automatically a Type-2? (FWIW: My C-Peptide is low, but slightly inside the "normal" range.)

In the final analysis all of us, Type-1's, 2's, and even the Pre-D's share a concern about how to best manage our BG levels. Each one responds, or fails to respond, to certain treatment regemens.

I don't remember who the signature block belongs to, but there is one who sums it all up in: "we don't have a stinking clue."

If somebody asked "WIll the real diabetic please stand up" I'm not sure I'd know exactly what to do, but I'd probably stand up anyway.

BlueSky
05-26-2008, 05:40 PM
... If somebody asked "WIll the real diabetic please stand up" I'm not sure I'd know exactly what to do, but I'd probably stand up anyway.
Ronin,

I guess there are two possibilities for you. Either you have autoimmune diabetes (even a negative antibody test doesn't preculde this), or you have insulin resistance but fall into BriOnH's "other 20%". These are people whose insulin resistance is not related to calorie consumption and activity levels. Perhaps something else caused that gene to be expressed. ;)