The largest, most comprehensive and impressive study to date to document the beneficial effects of lifestyle modification is the Diabetes Prevention Program (DPP) . The DPP randomly assigned 3,234 non-diabetic individuals with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice a day), or a lifestyle modification invention with the goals of a 7% weight loss and 150 min of physical activity per week. Average follow-up was 2.8 years. Results were dramatic. The lifestyle modification group reduced the incidence of type-2 diabetes by 58%, the metformin group by 31%, compared to placebo. The lifestyle modification intervention was significantly more effective than metformin. Beneficial effects of the lifestyle intervention were even seen on nontraditional cardiovascular risk factors including concentrations of C-reactive protein and fibrinogen .
In a similar study done in Finland, 522 middle-aged, overweight men and women with impaired glucose tolerance were randomly assigned to either a lifestyle intervention or control group . Each participant in the intervention group received individualized counseling aimed at weight reduction, improved diet, and increased physical activity. The mean follow-up was 3.2 years. The lifestyle intervention group had a significant reduction of 58% in the relative risk of developing diabetes, similar to the results of the DPR The reduction in risk was directly associated with beneficial changes in lifestyle.
The DPP researchers also reported results on the 53% of participants (n = 1,711) who had the metabolic syndrome at baseline. The incidence of the metabolic syndrome was reduced by 41% in the lifestyle group and by 17% in the metformin group, compared with placebo . The researchers attributed the dramatic effect of lifestyle modification on both the prevention of incident metabolic syndrome and a reduction of its overall prevalence primarily to reductions in waist circumference and in blood pressure. They concluded that their results demonstrate the value of lifestyle intervention in both the prevention and treatment of the syndrome, above and beyond improvement in glycemia alone and that lifestyle intervention may reduce risk in individuals with impaired glucose tolerance.
Currently, the ongoing Look AHEAD (Action for Health in Diabetes) study has as its primary hypothesis that an intensive lifestyle intervention similar to DPP to reduce weight and increase physical activity will reduce cardiovascular morbidity and mortality . In more than 5,000 obese adults with type-2 diabetes the study is comparing the long-term (up to 11.5 years) effects of an intensive lifestyle intervention designed to achieve and maintain a modest weight loss through decreased caloric intake and increased physical activity versus a control condition of diabetes support and education on the combined incidence of serious cardiovascular events, i.e. cardiovascular death, nonfatal myocardial infarction, and non-fatal stroke. Additional research goals include comparisons of cardiovascular disease risk factors, mortality, diabetes-related metabolic factors and complications, intervention safety, indices of health, quality of life, and a number of economic outcomes. A significant number of participants also have the dysmetabolic syndrome. This study is the first long-term randomized controlled trial to assess the effects of lifestyle intervention with reduced mortality as a primary outcome.
The results of the DPP and Finnish Diabetes Prevention Study (FDPS) document the importance of lifestyle modification as the primary therapeutic intervention in individuals with the dysmetabolic syndrome, given the fact that obesity, unhealthy diet, and physical inactivity are considered to be the primary underlying risk factors for the development of the syndrome. Results from the Look AHEAD trial may also help document the role of lifestyle change as significant in reducing mortality. Through lifestyle modification aimed at the
Goal setting Self-monitoring Stimulus control Cognitive restructuring Stress management Relapse prevention Social support Contracting development of a healthy diet, increased physical activity, and behavior modification, weight loss is the primary key to treating the dysmetabolic syndrome.
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