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Jeff Sutherland

Twice the Energy with Half the Stress

Diabetes: Improved Lifestyle Beats Drugs

Last week at the eHealth Developers Summit, I made the point that nutrition and exercise can eliminate 50% of disease, alternative medicine another 35%, and electronic frequency instruments at least another 10%. Hospitals admissions and clinic visits could be reduced by 95%. It takes knowledge, committment, and ability to change behaviors. This is a very good number, because Brent Lowensohn, Director of IT Advanced Technologies at Kaiser Foundation Health Plan and Hospitals, predicts a 15-fold increase in clinic visits over the next decade due to aging baby boomers, a problem that the current health system cannot possibly handle (see MIT Media Lab Future of Health Technology Summit).

A senior staff member of the Kellogg Foundation asked me for examples to support my argument and I gave a few. To my surprise, I returned home and found a recent New England Journal article showing that a 7% decrease in body weight and 150 minutes of exercise per week reduced the incidence of type 2 diabetes by 58%. The best drugs could do was a 31% reduction and this does not take into account the negative side effects of drugs or the positive side effects of lower weight and exercise on everything else except type 2 diabetes.

Alas, people continue to argue about the impact of nutrition and exercise as they did with smoking years ago. The smoking argument has largely stopped now that R.J. Reynolds was fined $144.9B in July 2000, and Phillip Morris was fined $28B last month (see today’s New York Time business section). But I digress, let’s look at the New England Journal of Medicine on diabetes.

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group.

Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA.

BACKGROUND: Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors–elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle–are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes.

METHODS: We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups.

RESULTS: The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin.

CONCLUSIONS: Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.

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