How to Delay or Avoid Developing Type 2 Diabetes

Research shows that you prevent, delay and manage diabetes through lifestyle changes, weight loss, and increased physical activity, along with diabetes medication, metformin.

Diabetes Prevention Program Research Results

The Diabetes Prevention Program (DPP) research results indicate that millions of high-risk people can delay or avoid developing type 2 diabetes by losing weight through regular physical activity and a diet low in fat and calories. Weight loss and physical activity lower the risk of diabetes by improving the body's ability to use insulin and process glucose. The DPP also suggests that metformin can help delay the onset of diabetes.

Participants in the lifestyle intervention group—those receiving intensive individual counseling and motivational support on effective diet, exercise, and behavior modification—reduced their risk of developing diabetes by 58 percent. This finding was true across all participating ethnic groups and for both men and women. Lifestyle changes worked particularly well for participants aged 60 and older, reducing their risk by 71 percent. About 5 percent of the lifestyle intervention group developed diabetes each year during the study period, compared with 11 percent of those in the placebo group.

Participants taking metformin reduced their risk of developing diabetes by 31 percent. Metformin was effective for both men and women, but it was least effective in people aged 45 and older. Metformin was most effective in people 25 to 44 years old and in those with a body mass index of 35 or higher, meaning they were at least 60 pounds overweight. About 7.8 percent of the metformin group developed diabetes each year during the study, compared with 11 percent of the group receiving the placebo.

Lifestyle Changes to Prevent, Delay and Manage Diabetes

In the years since the DPP was completed, further analyses of DPP data continue to yield important insights into the value of lifestyle changes in helping people prevent type 2 diabetes and associated conditions. For example, one analysis confirmed that DPP participants carrying two copies of a gene variant, or mutation, that significantly increased their risk of developing diabetes benefited from lifestyle changes as much as or more than those without the gene variant. Another analysis found that weight loss was the main predictor of reduced risk for developing diabetes in DPP lifestyle intervention group participants. The authors concluded that diabetes risk reduction efforts should focus on weight loss, which is helped by increased exercise.

Analyses of DPP data have added to the evidence that changes in diet and physical activity leading to weight loss are especially effective in helping reduce risk factors associated with both diabetes and cardiovascular disease, including high blood pressure and metabolic syndrome. A person with metabolic syndrome has several of a specific group of risk factors for developing diabetes and heart disease, such as having excess fat deposited around the waist, high triglyceride levels, and high fasting blood glucose levels. One analysis found that DPP participants in the lifestyle intervention group who did not have metabolic syndrome at the beginning of the study—about half of the participants—were less likely to develop it than those in the other groups. Another analysis of DPP data found that the presence of high blood pressure in DPP participants decreased in the lifestyle intervention group but increased in the metformin and placebo groups over time. Measures of triglyceride and HDL cholesterol levels also improved in the lifestyle intervention group. A third analysis found that levels of C-reactive protein and fibrinogen—risk factors for heart disease—were lower in the metformin and lifestyle intervention groups, with a larger reduction in the lifestyle group.

In addition, one study focused on urinary incontinence in women who participated in the DPP. Women in the lifestyle intervention group who lost 5 to 7 percent of their body weight through dietary changes and exercise had fewer problems with urinary incontinence than women in the other study groups.

Points to Remember

• The DPP showed that people at risk for developing diabetes can prevent or delay the onset of diabetes by losing a modest amount of weight through diet and exercise. DPP participants in the lifestyle intervention group reduced their risk of developing diabetes by 58 percent during the study.
• DPP participants who took the oral diabetes medication metformin also reduced their risk of developing diabetes, but not as much as those in the lifestyle intervention group.
• The DPP's impact continues as new research builds on the study's results to find the best ways to delay, prevent, and treat diabetes.

Hope through Research

The DPP contributed to a better understanding of how diabetes develops in people at risk and how they can prevent or delay the development of diabetes by making behavioral changes leading to weight loss. These findings are reflected in recommendations from the American Diabetes Association for the prevention or delay of type 2 diabetes, which stress the importance of lifestyle changes and weight loss. The DPP's impact continues as new research, building on the study's results, seeks the most effective ways to prevent, delay, or even reverse diabetes.

DPP researchers continue to examine the roles of lifestyle and metformin and other diabetes medications in preventing type 2 diabetes. They also continue to monitor participants to learn more about the study's long-term effects through the Diabetes Prevention Program Outcomes Study (DPPOS), a follow-up to the DPP. DPPOS is examining the impact of long-term risk reduction on diabetes-related health problems, such as nerve damage and heart, kidney, and eye disease.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

Sources:

• National Diabetes Information Clearinghouse, NIH Publication No. 09-5099, October 2008
• NDIC