A series of papers out in the New England Journal of medicine on March the 14th 2010 have failed to add any substantive weight to the use of medication in the prevention of diabetes and cardiovascular disease. [1],[2],[3]
The continued expansion of the western global waistline and incidence of diabetes has provided fertile opportunity for a wide range of clinical trials designed to uncover strategies for incidence of diabetes reduction.[4] There is no surprise in the discovery that making significant changes to people’s lifestyles, eating less and being more active, the primary causes of weight gain, also have a consistent reduction in type II diabetes risk. The real success has also been in the associated benefits in reduction of related cardiovascular disease risk[5] and raising of mood.[6]
Naturally pharmaceutical trials have also been conducted as the delivery of a medication that achieves the same as can be achieved through positive lifestyle changes is appealing to the drug industry as well as those who are unable or unwilling to engage in suitable changes to their day to day life choices. The two best known medications: Metformin and Rosilitazone have had a mixed level of success in the reduction of diabetes incidence.1
Two large trials under the title Diabetes Prevention Programme have undertaken a comparative approach to their data analysis. They divided the patients into groups that received – in a random manner – lifestyle changes, medication and a placebo. (ClinicalTrials.gov number, NCT00004992 [ClinicalTrials.gov] ) and its long-term outcome study (NCT00038727 [ClinicalTrials.gov] )
There was a remarkable difference between Metformin and Lifestyle approach. The change in diet and exercise when compared to the placebo therapy of 58% at three years and 34% after 10. Metformin managed to achieve some benefit but was almost only half as effective showing 31% incidence of reduction after 3 and 18% after 10.[7]
Safe, inexpensive, and acceptable interventions that lower glycaemia, halt or delay the progression to diabetes, and reduce cardiovascular disease are highly desirable. The role of lifestyle changes remains the most effective low risk intervention available. The use of specific nutrients to enhance insulin receptor sensitivity and maintain well controlled blood sugar levels may well contribute to this by reducing the problems associated with reactive hypoglycaemia induced snacking.[8],[9],[10]
Comment
The role of nutrition and lifestyle changes in the prevention of obesity and diabetes (typeII) with all the associated health risks are best undertaken by changing the foods chosen and the exercise undertaken. The role of specific nutrients to support the receptor function, so that insulin is better able to maintain stable blood sugars will assist compliance and promote a beneficial outcome. This is not news to nutritional therapists, but remains a contentious issue with patients watching their blood sugars and medics unwilling or unable to promote suitable lifestyle promotion.
References
[1] The NAVIGATOR Study Group, Effect of Valsartan on the Incidence of Diabetes and Cardiovascular Events
N Engl J Med 2010 0: NEJMoa1001121 View Abstract
[2] The NAVIGATOR Study Group, Effect of Nateglinide on the Incidence of Diabetes and Cardiovascular Events
N Engl J Med 2010 0: NEJMoa1001122 View Abstract
[3] The ACCORD Study Group,Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus N Engl J Med 2010 0: NEJMoa1001282 View Abstract
[4] Crandall JP, Knowler WC, Kahn SF, et al. The prevention of type 2 diabetes. Nat Clin Pract Endocrinol Metab 2008;4:382-393. View Abstract
[5] Goldberg RB, Temprosa M, Haffner S, et al. Effect of progression from impaired glucose tolerance to diabetes on cardiovascular risk factors and its amelioration by lifestyle and metformin: the Diabetes Prevention Program randomized trial by the Diabetes Prevention Program Research Group. Diabetes Care 2009;32:726-732. View Full Paper
[6] Vocks S, Hechler T, Rohrig S, Legenbauer T..Effects of a physical exercise session on state body image: The influence of pre-experimental body dissatisfaction and concerns about weight and shape. Psychol Health. 2009 Jul;24(6):713-28. View Abstract
[7] Diabetes Prevention Program Research Group. 10-Year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009;374:1677-1686 View Abstract
[8] Althuis MD, Jordan NE, Ludington EA, Wittes JT. Glucose and insulin responses to dietary chromium supplements: a meta-analysis. Am J Clin Nutr. 2002 Jul;76(1):148-55. View Abstract
[9] Facchini F, Coulston AM, Reaven GM. Relation between dietary vitamin intake and resistance to insulin-mediated glucose disposal in healthy volunteers. Am J Clin Nutr. 1996 Jun;63(6):946-9. View Abstract
[10] Montonen J, Knekt P, Järvinen R, Reunanen A. Dietary antioxidant intake and risk of type 2 diabetes.
Diabetes Care. 2004 Feb;27(2):362-6. View Abstract
