Transcript: How to Prevent Prediabetes from Turning into Diabetes
In just one decade, the number of people with diabetes has more than doubled. According to the Centers for Disease Control and Prevention, by 2050, one out of every three of us may have diabetes. What’s the big deal?
Well, the consequences of diabetes are legion: the #1 cause of adult-onset blindness, the number one cause of kidney failure, and the number one cause of surgical amputations. What can we do to prevent it?
Well, the onset of type 2 diabetes is gradual, with most individuals progressing through a state of prediabetes, a condition now striking approximately 1 in 3 Americans, but only about 1 in 10 even knows it. Since current methods of treating diabetes remain inadequate, prevention is preferable, but what works better, lifestyle changes or drugs? We didn’t know until this landmark study was published in New England Journal of Medicine.
Thousands were randomized to get a good double dose of the leading antidiabetes drug or diet and exercise. The drug, metformin, is probably the safest diabetes drug there is. Causes diarrhea in about half, makes 1 in 4 nauseous, about 1 in 10 suffer from asthenia, from the Greek meaning lack of strength, physical weakness and fatigue, but only about 1 in 67,000 are killed by the drug every year.
And it worked. Compared to placebo, in terms of the percentage number of people developing diabetes within the four-year study period, fewer people in the drug group developed diabetes.
But diet and exercise alone worked better. The lifestyle intervention reduced diabetes incidence by 58 percent, compared to only 31 percent with the drug. The lifestyle intervention was significantly more effective than the drug, and had fewer side-effects. More than three quarters of those on the drug reported gastrointestinal symptoms, though there was more muscle soreness reported in the lifestyle group, on account they were actually exercising.
That’s what other studies have subsequently found: non-drug approaches are superior to drug-based approaches for diabetes prevention. And the 50% or so drop in risk was not for people that actually improved their diet and lifestyle, but just for those instructed to improve their diet and lifestyle, whether or not they actually did it.
This is one of the most famous diabetes prevention studies. 500 people with prediabetes randomized into a lifestyle intervention or control group, and during the trial, the risk of diabetes was reduced by that same 50-60%, but only a fraction of the patients met the modest goals. Even in the lifestyle intervention group, only about a quarter were able to eat enough fiber, meaning whole plant foods, and cut down on enough saturated fat, which in this country is mostly dairy, dessert, chicken, and pork. But they did better than the control group, and fewer of them developed diabetes because of it. But what if you looked just at the folks that actually made the lifestyle changes, met at least 4 out of 5 of those wimpy goals? They had zero diabetes. None of them got diabetes. A 100% drop in risk.
Bottom line: Type 2 diabetes can be prevented by changes in lifestyle even in high-risk prediabetic subjects.
The fact, then, that type 2 diabetes, a largely preventable disorder, has reached such epidemic proportion is a public health humiliation.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
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