By Richard R. Rubin, Ph.D., C.D.E. Have you made your new year’s resolution? Mine is to get back on track with my exercise. Over the years I’ve been pretty dedicated to my running and weightlifting, but the past year or so I’ve really slipped. I don’t like that. And I’ve been eating a little less carefully. I don’t like that either. So I’m recommitting myself, reminding myself of all the reasons I used to exercise regularly, especially the joy I feel running along the little stream that flows beside a wooded path near my office. There are moments when my senses are so full and my body feels so strong that I feel truly blessed. I need that feeling, yet somehow I get wrapped up in my busy routine and don’t give myself the time. Living a healthy lifestyle is not easy, but the benefits can be profound. A research project I’ve been working on for the past 8 years proves that even moderate changes in diet and activity can prevent type 2 diabetes. This study is called the Diabetes Prevention Program (DPP). Over 3,000 people participated in the DPP, at 27 research centers all over the country. To qualify for the DPP participants had to be overweight and they had to have a condition called impaired glucose tolerance (IGT). People with IGT have blood sugar levels higher than normal but not high enough to be called diabetes. About half of all people with IGT eventually develop type 2 diabetes, so this is a group that would really benefit from prevention efforts. Preventing diabetes is important for everyone. We face a veritable high blood sugar epidemic in our country and around the world, driven largely by increases in weight and decreases in activity. In the next 50 years the number of people in the United States who have diabetes will double. Both IGT and type 2 diabetes are more common among
African-Americans, Hispanic Americans, Asian Americans, American Indians, and Pacific Islanders, and for the first time we are seeing these conditions in young people, as well. So, when I joined a group of researchers in 1993 to plan the DPP, the time was right to look for ways to prevent diabetes. People who qualified to participate in the DPP had to be overweight and have IGT. We recruited almost half of our participants from racial and ethnic groups that suffer high rates of diabetes. When participants joined the study they were randomly assigned to one of three groups. One group received coaching in a healthy lifestyle designed to help them lose weight. These participants were counseled on their diet and exercise, and their goal was to be active (for most this meant walking) 30 minutes a day 5 days a week, and to lose 7 percent of their weight and keep it off. For a 200-pound person that meant losing 14 pounds and keeping it off. The two other groups of participants took pills. One group took a medication called metformin and the other group took placebos, pills that looked just like the metformin but contained no active medication. In well-designed studies like the DPP scientists always include a control group that gets no active treatment. That makes any benefits of the active treatments clear and convincing, since changes in all groups can be compared. In the DPP neither participants nor study staff knew which pills were metformin and which were placebos. The results of the DPP were really impressive, and we owe most of this success to the dedicated participants. When the study was ended in April 2001, 95 percent of the participants were still actively involved in the program. Depending on when they joined the DPP, participants were in the study between 2 /and 4 years, and for all that time they did a great job losing weight, walking, taking their study pills, coming to their appointments and doing all the other things that are part of a big study like the DPP. This dedication paid off, and the active lifestyle group benefited most. People in this group made moderate changes in their eating and activity. At the end of the study the average participant had lost about 10 pounds and was walking about 20 minutes a day. Making these changes and sustaining them takes work, for sure. But these are realistic goals for many people. And in the DPP the group that made these changes cut their rate of progression from IGT to diabetes by 58 percent compared to the control group that took the placebo pills. So relatively small changes in behavior made a big difference in protecting people from getting diabetes. I was especially pleased to see that the benefit of healthier lifestyle in the DPP held across the board: for men and women, for people from every racial and ethnic group and for people of all ages. In fact, people over the age of 60 got the biggest benefit from being in the active lifestyle group; their rate of progression to diabetes was 71 percent lower than people the same age who took the placebo pills. DPP participants who took metformin also benefited: their rate of progression to diabetes was 31 percent lower than people in the placebo pill group. That means both lifestyle and metformin were effective in preventing diabetes during the course of the DPP, and that lifestyle changes were about twice as effective as the medication. What do the results of the DPP mean to you? If you have IGT, the results apply to you directly. But you almost certainly don’t know if you are one of the estimated 21 million Americans with IGT because you have never been tested for it. You have probably never even heard of IGT before, and your health care provider may not know much either. If you have the risk factors for IGT and type 2 diabetes, including being overweight and having family members with diabetes, you may have one of these conditions and not know it. This is especially true of you are African-American, Hispanic American, Asian American, American Indian, or Pacific Islander. If you are at risk, talk with your health care provider about what you should do. The American Diabetes Association and other groups are putting together statements for health care providers and the public, including recommendations for what to do based on the DPP results. These statements might be available by the time you read this column. If you already have diabetes you can help protect family members and friends who don’t have it yet. And you can use the DPP results to help yourself. For me the true bottom-\ line message of the DPP is this: things that work to help people control type 2 diabetes also work to prevent it. Staying active and maintaining a healthy weight help you stay heart-healthy, flexible and positive, so you can keep doing the things you want and need to do. Now I think I will go out for that run. Happy holidays and a healthy new year! (originally written January 2002) Richard Rubin, Ph.D., C.D.E., associate professor of medicine and pediatrics at Johns Hopkins, is the co-author of Psyching Out Diabetes: A Positive Approach to Your Negative Emotions, Sweet Kids, and The Johns Hopkins Guide to Diabetes. He also has written extensively on the effects of diabetes education, psychological problems associated with diabetes and techniques for counseling people with diabetes. Updated October 2002 1999-2002 Diabetes Wellness News. Reprinted with permission of Diabetes Research and Wellness Foundation. Last Updated: 10/18/2002
The Johns Hopkins University 1996-2003. All rights reserved. This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.
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