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New Diabetes Study Demonstrates the Power of Behavioral Change
A new study documenting the efficacy of lifestyle change in preventing or delaying type 2 (non-insulin-dependent) diabetes stands as possibly the strongest validation to date of the power of behavioral change.
Members of the Diabetes Research Group identified 3,234 adults whose blood sugar levels were elevated, but not yet high enough for a diagnosis of diabetes. These high-risk individuals were assigned to three groups: one receiving a placebo plus standard lifestyle change recommendations, a second receiving a medication usually used to lower blood sugar in type 2 diabetes (metformin) plus standard lifestyle change recommendations, and a third receiving an intensive lifestyle intervention designed to promote weight loss, increased physical activity and diet change.
The study was supposed to continue for six years -- but after only four, the findings were so conclusive that it was ended early. At that point, the incidence of diabetes was reduced by 58 percent in the lifestyle intervention group and by 31 percent in the medication group, when compared to the placebo group.
"We had no way of knowing what the results would be going in," program coordinator Sanford Garfield, Ph.D., from the National Institute of Diabetes and Digestive and Kidney Diseases Program Office, told HABIT. "The results surprised even us."
One of the most surprising and rewarding findings, Garfield notes, is that only a modest weight loss and small increase in physical activity were needed to achieve the dramatic results seen in the lifestyle intervention group. The fact that a very realistic level of change is all that's required, Garfield points out, bodes well for translating the study protocol into an effective intervention for broad-scale use.
So does the high level of success seen across the diverse ethnicities, cultures and ages represented in the study group. "The most surprising finding of all was that the most dramatic lifestyle intervention results were seen in the oldest participants," Garfield notes. "We often assume that these are the people least receptive to change."
"These findings clearly demonstrate that if you want to delay or prevent type 2 diabetes, lifestyle intervention is the place to start," Garfield observes.
The study's success "has turned a research question into a public health issue," says Garfield. "If you look at the effectiveness of the lifestyle intervention, and the number of individuals that must be treated to prevent one case of diabetes, the results are well within the range of other interventions."
Because the research protocol included intensive, individualized and ongoing lifestyle counseling, Garfield notes that the immediate goal is to translate the study protocol into one more appropriate for broad application. The NIDDK is encouraging translational research through a program announcement, PA-01-069. For the full announcement, go to grants.nih.gov
In addition, Garfield told HABIT, a decision is being made regarding how to proceed with the original study cohort -- continuing to provide proven effective interventions or following their progress over time.
For more information on the study, see the February 7, 2002 issue of The New England Journal of Medicine.
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