"How to Prevent Prediabetes
from Turning into Diabetes" In just one decade, the number of people
with diabetes has more than doubled. According to the Centers for Disease
Control and Prevention, by 2050, one out of every three
of us may have diabetes. What’s the big deal? Well, the consequences
of diabetes are legion; the #1 cause of adult-onset blindness,
the #1 cause of kidney failure, the #1 cause of
surgical amputations. What can we do
to prevent it? Well, the onset of
type 2 diabetes is gradual, with most individuals progressing
through a state of prediabetes, a condition now striking
approximately 1 in 3 Americans, but only about 1 in 10
even knows it.
Since current methods of treating
diabetes remain inadequate, prevention is preferable,
but what works better? Lifestyle changes or drugs? We didn’t know until this landmark study
was published in New England Journal of Medicine. Thousands were randomized to
get a good double dose of the leading anti-diabetes
drug OR diet and exercise. The drug, metformin, is probably the
safest diabetes drug there is. Umm…does cause diarrhea in
about half of those who take it, makes 1 in 4 nauseous, about
1 in 10 suffer from asthenia, from the Greek meaning lack of strength,
causing physical weakness and fatigue, but the risk of being killed by the drug
is only about 1 in 66,000 every year.
And the drug worked. Compared to placebo, in terms
of the percentage of people developing diabetes within
the four years study period, fewer people in the drug
group developed diabetes. But diet and exercise
ALONE worked better. The lifestyle intervention reduced
diabetes incidence by 58%, compared to only
31% with the drug. The lifestyle intervention was significantly
more effective than the drug, AND had fewer side-effects. More than three quarters of those on the
drug reported gastrointestinal symptoms, though there was more muscle soreness
reported in the lifestyle group, on account they were
actually exercising. Other studies subsequently
found the same result: non-drug approaches superior to drug-based
approaches for diabetes prevention. And the 50% or so drop in
risk was not for people that actually improved their
diet and lifestyle, but just for those INSTRUCTED to
improve their diet and lifestyle, whether or not they actually did it.
Check this out: this is one of THE most
famous diabetes prevention studies. 500 people with pre-diabetes randomized into
a lifestyle intervention or control group, and during the trial, the risk of
diabetes was reduced by that same 50-60%, but only a fraction of the patients
met the modest goals. Even in the lifestyle intervention group, only
about a quarter were able to eat enough fiber, meaning whole plant foods and cut
down on enough saturated fat, which in this country is mostly dairy,
dessert, chicken, and pork.
But they did better than
the control group, and fewer of them developed
diabetes because of it. But what if you looked just at the folks
that actually made the lifestyle changes, met at least 4 out of 5
of those whimpy goals? They had ZERO diabetes.
None of them got diabetes. A 100% drop in risk. Bottomline: type 2 diabetes can be
prevented by changes in lifestyle even in high-risk
pre-diabetic subjects. The fact, then, that type 2 diabetes,
a largely preventable disorder, has reached such epidemic proportion
is a public health humiliation..