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Lifestyle changes can cut diabetes risk in half

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Studies show that lifestyle changes can delay Type 2 diabetes in people who are at risk.

Q: On my last routine blood work, my blood sugar was just above the normal range. Am I destined to have diabetes?

A: Making small changes to your habits and daily lifestyle now can help prevent or at least delay the onset of Type 2 diabetes.

A large study published almost 20 years ago showed the strength of the connection between lifestyle habits and Type 2 diabetes risk. The Diabetes Prevention Program (DPP) trial, which followed thousands of participants in 27 areas across the country from 1996 to 2001, was the first major effort to look at whether lifestyle changes were more or less effective than drug intervention in preventing Type 2.

The study, published in 2002, included a diverse group of 3,234 Americans who had prediabetes and were overweight. It found that those who lost a modest amount of weight (just 5% to 7% of their starting weight) and increased their physical activity by about 30 minutes a day reduced their risk of developing Type 2 diabetes by an impressive 58%. The diabetes drug metformin also lowered risk, but less dramatically — by 31%.

Since the original DPP trial, which lasted three years, there have been several follow-up studies with the original participants. In these long-term studies, participants have been asked to keep up the same lifestyle changes or metformin dose for over 20 years. The most recent 22-year follow-up study revealed that over 22 years, lifestyle changes reduced the development of Type 2 diabetes by 25%, while metformin reduced it by 18%.

Other studies have taken the original data from the DPP study and analyzed it to look for more connections. One analysis found that the lifestyle changes in the DPP study had as much benefit for people at high genetic risk for Type 2 diabetes as those at lower genetic risk. Other studies in China, Finland, Europe, India and Canada have also found that lifestyle changes can delay Type 2 diabetes in people who are at risk. This suggests that even if Type 2 diabetes runs in your family, you can lower your risk of developing it by adopting some habits that help you be more active and lose a little weight.

Best of all? You don’t have to try to make these changes on your own. Perhaps the best thing to come out of the DPP study was a nation-wide program that provides support and encouragement to people with prediabetes wanting to make these changes. The intervention that was used in the original DPP study was so successful that the CDC used it as a model to create the National Diabetes Prevention Program. You can find a CDC-certified lifestyle change program in your area by visiting the CDC website (https://www.cdc.gov/diabetes/prevention/index.html).

(Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)

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