Lifestyle Interventions Improves Mortality Outcomes in Prediabetes: World Diabetes Day

Amidst a large number of cardiovascular (CV) outcome data getting released on various anti-diabetic medications, we now have outcome data on one of the oldest, and most certainly, the safest modality in the management of Type 2 Diabetes, i.e. Lifestyle Interventions

We now have hard evidence that combined lifestyle interventions (diet, exercise, or diet plus exercise) in individuals with Impaired Glucose Tolerance (IGT) or Prediabetes could delay the onset of the development of diabetes by almost 4 years, reduce cardiovascular events by 26%, decrease the incidence of microvascular complications by 35% and cause a decline in CV deaths by 33%

It has been empirically known that lifestyle interventions could delay the onset of type 2 diabetes in people with impaired glucose tolerance, and careful interventions at this stage could possibly reverse the metabolic disturbances and lead to normoglycemia

However, whether such lifestyle interventions resulted in improving cardiovascular outcomes and mortality was uncertain until now. However, based on the results published from this latest study which aimed at assessing the long-term effects of lifestyle interventions in people with impaired glucose tolerance on the incidence of diabetes, its complications, and mortality, we now have quite substantial evidence.

About the Study

This study, which was initiated in 1986, included 577 adults with impaired glucose tolerance, at 33 centers, where patients were randomly assigned to either be a control center or provide one of three interventions (diet, exercise, or diet plus exercise)

The study participants were followed up for a period of 30 years to understand the effects of such interventions on the incidence of development of diabetes, cardiovascular events, microvascular complications, cardiovascular death, all-cause mortality, and changes in life expectancy.

The results indicated during the 30-year follow-up, compared with control,

• The combined lifestyle intervention group had a median delay in diabetes onset of 3•96yrs

• Fewer cardiovascular disease events (relative risk reduction by 26%)

• Lower incidence of microvascular complications (relative risk reduction by 35%)

• Fewer cardiovascular disease deaths(relative risk reduction by33%)

• Fewer all-cause deaths (relative risk reduction by 26%), and

• Average increase in life expectancy of 1•44 years

The study interpreted that such findings provide strong justification to continue to implement and expand the use of such interventions to curb the global epidemic of type 2 diabetes and its consequences.

Potential Application of such evidence– Communicate with a Prediabetic

For diligent practitioners of diabetes who battle this lifestyle epidemic of modern times in everyday practice, it would indeed be interesting to closely observe the impact of sharing such strong evidence favoring lifestyle interventions with their patients and notice the manner in which communicating such information could influence lifestyle behavior and improve its adherence

Well, far easier said than done, and certainly not always feasible in many practice settings in our country, but surely worthy to be borne in mind.

Communication in Medicine – Essential Component of Patient Care

In spite of such humongous developments in diabetes care, the prevalence figures still remain humbling; so while we keep knocking on doors of newer modalities, it may be a skillful art of medicine to revisit and assess the effectiveness of old ones.

For a country that has an estimated 24 million adults (20 – 79 years) living with impaired glucose tolerance (based on 2017 statistics) and this figure is anticipated to reach 41 million by 2045, every safe and cost-effective modality to tackle this lifestyle epidemic deserves emphasis and reinforcement in an age which is striding towards individualized patient care and personalized medicine. Communicating the impact of lifestyle intervention with a Prediabetic is most likely our last opportunity towards primordial prevention.

Dietary Management Added to Diabetes Care – Reduces HbA1c by 1 to 2 %

One of the key messages brought out by the recent Canadian Clinical Practice Guidelines on the Management of Diabetes is that Nutrition therapy could help to reduce glycated hemoglobin (HbA1c) by 1.0% to 2.0% and when used appropriately with other components of diabetes management, can further improve clinical and metabolic outcomes.

Communicating Means Caring!!

A renowned English orator had once sharply remarked, "Whatsoever was the father of a disease, an ill diet was the mother". The global pervasiveness of Type 2 Diabetes personifies the same.

Can we just attempt and tell our Prediabetic patient next time "There is some evidence to suggest that if you see a dietician improve your eating habits and follow them sincerely, your chances of developing cardiovascular complications can reduce by one-quarter" Even if it may slightly influence the healthy lifestyle behavior amongst 1 in 100 pre-diabetic patients, the overall impact could still be quite significant.

References

Adapted from

1. Gong Get al, Morbidity, and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study, Lancet Diabetes Endocrinol. 2019 Apr 26. PII: S2213-8587(19)30093-2.

2. John L. Sievenpiper et al, 2018 Clinical Practice Guidelines Nutrition Therapy, Can J Diabetes 2018; 42: S64–S79

3. Suvi Karuranga et al, International Diabetes Federation, Diabetes Atlas 2017; 8th Edition: Pages 1-145

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