Are lifestyle changes alone always beneficial in diabetes?

This study focused on how effective lifestyle changes are in reducing the progression of prediabetic patients to type 2 diabetes. In patients already diagnosed with diabetes, it focused on whether lifestyle changes can reduce the progression of diabetic complications.

Type 2 diabetes occurs when the body has grown resistant to insulin. Uncontrolled diabetes has potential long term consequences such as kidney damage (nephropathy), loss of sensation in the extremities (peripheral neuropathy), blindness (retinopathy), and loss of limbs. It also has a strong association with cardiovascular disease, such as heart attacks.

 Some of the high-risk factors associated with diabetes can be altered, and these are called modifiable risk factors. These include changing the patient’s diet, weight and level of physical activity. While many reviews report the benefit of diet or lifestyle interventions, there are none to date that review studies evaluating a combination of diet, exercise and other interventions.

Two reviewers evaluated articles and included only those that had either high-risk participants (those with prediabetes; 9 studies) or recently diagnosed type 2 diabetic patients (11 studies). Each study evaluated an average of 200 participants who had undergone an intervention with a diet component, an exercise component and at least one other lifestyle component (such as counseling, smoking cessation or behavior modification).

In high-risk participants, the study found that those who had a lifestyle intervention in diet and exercise, diet only or exercise only had a moderately reduced rate of development of diabetes. This ranged from a 51% reduced risk at 6 years of follow-up to 43% reduced risk at 20 years of follow-up.

In diabetic patients, there was no significant difference found in the rate of diabetic complications between intervention and non-intervention groups at more than 10 years of follow-up. The study found no difference in the rate of heart attack, stroke, chest pain or amputation. There was no reduction in nerve damage; however there was a trend toward reduced progression of kidney damage and eye damage in the intervention group.

The authors concluded that lifestyle interventions are beneficial for patients at risk for diabetes, while the benefits are less clear for those with diagnosed diabetes.

The articles referenced in this study followed patients for 10-20 years. In that time, patients may have stopped following the lifestyle changes.

If prediabetic, consult your doctor on the appropriate lifestyle changes to reduce the risk of progression to type 2 diabetes.