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Reduction in Type 2 Diabetes With Lifestyle Intervention vs Metformin

September 18, 2010 | Filed Under: Uncategorized | Comments(0)

A study in the New England Journal of Medicine (Feb. 7, 2002, 6/346:393-403) notes that some Type 2 diabetes risk factors – elevated glucose concentrations in the fasting state (FG) and after an oral glucose load, overweight and a sedentary lifestyle – are potentially reversible. They hypothesized that modifying these factors with a lifestyle intervention program or administration of Metformin would prevent or delay the development of diabetes.

The authors randomly assigned 3,234 non-diabetic 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% weight loss and at least 150 minutes of physical activity per week. Mean age of the participants was 51, and the mean body-mass index (BMI) was 34.0; 68% were women, 45% were members of minority groups.

Average time of follow-up was 2.8 yrs. The percent of those who got diabetes was 11.0 (if they relied on placebo only), 7.8 (if they took Metformin only), and 4.8 (if they used lifestyle approaches) cases per 100 person-years, respectively. Compared to placebo, lifestyle intervention reduced diabetes by 58%, and Metformin by 31% as compared with placebo. The lifestyle approach was significantly more effective than Metformin.

Implications: Lifestyle approaches are virtually twice as effective as a drug alone (58% vs 31%). Yet, despite this evidence-based treatment superiority – which is reported in virtually all studies of chronic diseases where lifestyle approaches are compared with drugs alone – physicians continue to push a drug treatment only. And, this, even if it adds to the side effects from the 2-3 other drugs doctors tend to routinely prescribe when treating the related symptoms of Type 2 diabetes.

Chronic non-cancer pain treatments reveal a similar pattern: for restoring their ability to function and reducing pain and utilization of medical services, drugs alone prescribed by non-specialists make pain worse, while specialists provide moderate short-term improvement with appropriately prescribed pain drugs alone. And both are significantly less effective than a combination drug-lifestyle modification program.

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