New statistics show an alarming increase in type 2 diabetes of pandemic proportions worldwide, which is linked to the continuing, dramatic increase in obesity now being widely reported in the U.S. and worldwide.
Addressing this worldwide “diabetes pandemic,” a new UK Study, just published in the The Lancet medical journal, has found that an intensive dietary intervention soon after diagnosis of type 2 diabetes, helping the patient to lose weight, resulted in significant improvements in glycaemic control and other measures of diabetes, compared to a control group of patients who received the standard care for diabetes.
The new study conducted by Dr R C Andrews of the School of Clinical Sciences, University of Bristol, UK, and colleagues, and funded in part by the UK Department of Health, appears in the July 9, 2011 issue of The Lancet.
Introduction: The Diabetes Pandemic
A Commentary entitled, The diabetes pandemic, published in the same issue of The Lancet introduces the subject with the startling statement: “It was hard not to notice the announcement at the 71st American Diabetes Association (ADA) meeting in San Diego, CA, USA (June 24—28): one in four US adults now has diabetes.”
The Commentary also cites another study reporting that, “the rate of diabetes worldwide has reached an alarming proportion,” and estimating that “the number of adults with diabetes has doubled within the past three decades,” worldwide.
The Commentary observes that: “Obesity is a prominent risk factor for type 2 diabetes, and with global obesity rates rising, the ensuing burden of type 2 diabetes looks set to worsen.”
The new UK study reported in the same issue of The Lancet, focusing on improvements in the treatment of type 2 diabetes, is thus especially timely, given these dire statistics on a dramatic increase in the number of cases of type 2 diabetes in the U.S. and worldwide, and the related statistics on the obesity epidemic now being widely reported among the populations of the U.S. and other countries.
The World Health Organization (WHO) reports that, “Worldwide obesity has more than doubled since 1980,” and “More than 220 million people worldwide have diabetes.” According to the WHO’s January, 2011 Fact Sheet on Diabetes: “Type 2 diabetes comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity.”
The UK Study: Early Dietary Intervention Significantly Improves Type 2 Diabetes
Methodology. The new U.K. study included 593 individuals between the ages of 30 and 80, who were diagnosed with type 2 diabetes within 5 to 8 months before their entry in the study. The participants were assigned randomly to a control group (99 persons), a group enrolled in an intensive diet intervention program (248 individuals), and a group given the intensive diet intervention plus an activity/ exercise intervention program (246 individuals).
The control group received the standard diabetes care, including initial dietary consultation and follow-up every six months.
The intensive diet intervention group were given an initial dietary consultation and continuing dietary consultations every three months, with near monthly nurse support. The dietary intervention was aimed at enabling the patients to lose 5% to 10% of their bodyweight and maintain this loss throughout the study. Each participant was given dietary guidance, based on the UK dietary guidelines and the Balance of Good Health leaflet from the UK Food Standards Agency. The guidance included how many portions of each food group to choose, with encouragement to choose foods in the lower ranges of energy density, fat content, and glycaemic index. [See, for example, the good foods for diabetes pictured in the photo above.] Each participant was encouraged to set individual goals, within the guidelines, at their first visit with the dietitian, and their progress was reviewed at each follow-up visit. Each patient saw the dietitian for one hour at the beginning of the study, and for 30 minutes at each follow-up visit. In addition, the patients saw a study nurse nine times during the study (about every 6 weeks), for reinforcement of their dietary advice and goal setting, and discussion of any other issues the patient wanted to raise.
The intensive diet intervention plus activity group received the same intensive dietary intervention as described above, plus a pedometer-based activity program.
The participants were measured at six months and again at 12 months for improvements in blood pressure and in glycated haemoglobin (HbA) concentration, a measurement advocated by scientists and accepted by the American Diabetes Association’s criteria for the detection and diagnosis of diabetes. They were also tested for weight, waist circumference, and insulin resistance compared with outcomes in patients receiving usual care.
Findings. After six months and at 12 months, both the dietary and the dietary + activity intervention groups showed significant improvements in HbA and blood pressure, compared to the control group. They also showed greater improvements in the other measures. However, in this study, no significant difference in the diabetes improvement measures was found between the dietary intervention group and the dietary intervention plus activity group.
The study authors stated:
The researchers expressed surprise that the activity program did not produce any significant additional benefit for the participants in this study, noting that previous studies had found that vigorous aerobic exercise did improve HbA concentrations.
In explanation of why the activity program in this study did not show significant additional benefit, they suggested that the “activity undertaken [in this study] might have been of insufficient intensity or been the incorrect type.” They also suggested that the timing of the activity intervention “could have been too early in the disease process to show additional response,” noting that “the intensive diet intervention plus activity worked better than the intensive diet intervention alone in patients who had high baseline HbA1c concentrations, insulin resistance, and BMI values than in those with lower values.” Finally, they suggested it could be that “the modification of two behaviours simultaneously diluted the effect of both [in this study].” “Qualitative interview results suggest that people use a trade-off system in which they reward themselves for additional exercise with increased food intake.”
The authors called for further research “to clarify whether different programmes or intensities of physical activity, longer interventions, or intervention at an earlier or later stage of diabetes will have benefits additive to those of dietary modification, and whether other benefits will become apparent with longer duration of follow-up.”
Conclusion. The researchers concluded that the result in this study “shows clearly that intensive dietary support soon after the diagnosis of type 2 diabetes is beneficial.”
This UK study is significant as one of the first large studies of relatively long-term duration to measure the effect of early dietary and physical activity interventions in patients recently diagnosed with type 2 diabetes. The authors note that most previous studies of diet and exercise interventions “were of short duration, involved small numbers of patients overall, and of these only a few had newly diagnosed type 2 diabetes.”
The study report in its entirety, entitled: “Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial,” is published in the July 9, 2011 issue of The Lancet.
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