Approximately 1 in 3 Americans have prediabetes, but only about 1 in 10 knows it. What works better at preventing it from turning into full-blown diabetes—drugs or diet and exercise?
How to Prevent Prediabetes from Turning into Diabetes
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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.
Please consider volunteering to help out on the site.
- J S Skyler. Microvascular complications: Retinopathy and nephropathy. Endocrinology and metabolism clinics of North America 2001 30(4):833 – 856.
- R E Pratley. The early treatment of type 2 diabetes. Am. J. Med. 2013 126(9 - Suppl - 1):S2 – 9.
- R W Glaser, N. R. Stoll. Development under sterile conditions of the sheep stomach worm haemonchus contortus (nematoda). Science 1938 87(2255):259 – 260.
- J D Eikenberg, B M Davy. Prediabetes: A prevalent and treatable, but often unrecognized, clinical condition. J Acad Nutr Diet 2013 113(2):213 – 218.
- W R Rowley, C Bezold. Creating public awareness: State 2025 diabetes forecasts. Population health management 2012 15(4):194 – 200.
- I Hopper, B Billah, M Skiba, H Krum. Prevention of diabetes and reduction in major cardiovascular events in studies of subjects with prediabetes: Meta-analysis of randomised controlled clinical trials. Eur J Cardiovasc Prev Rehabil 2011 18(6):813 – 823.
- T Lancet. Type 2 diabetes--time to change our approach. The Lancet 2010 375(9733):2193.
- J G Dohlman, H De Loof, M Prabhakaran, W J Koopman, J P Segrest. Identification of peptide hormones of the amphipathic helix class using the helical hydrophobic moment algorithm. Proteins 1989 6(1):61 – 69.
- J Tuomilehto, J Lindström, J G Eriksson, T T Valle, H Hämäläinen, P Ilanne-Parikka, S Keinänen-Kiukaanniemi, M Laakso, A Louheranta, M Rastas, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine 2001 344(18):1343 – 1350.
- K Khavandi, H Amer, J Brownrigg, B Ibrahim. Strategies for preventing type 2 diabetes: An update for clinicians. Therapeutic advances in chronic disease 2013.
- Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010 Oct 22;8:29.
- Centers for Disease Control and Prevention (CDC). Awareness of prediabetes--United States, 2005-2010. MMWR Morb Mortal Wkly Rep. 2013 Mar 22;62(11):209-12.
- Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.
Image thanks to feverpitched via 123rf. Image has been modified.
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.
Please consider volunteering to help out on the site.
- J S Skyler. Microvascular complications: Retinopathy and nephropathy. Endocrinology and metabolism clinics of North America 2001 30(4):833 – 856.
- R E Pratley. The early treatment of type 2 diabetes. Am. J. Med. 2013 126(9 - Suppl - 1):S2 – 9.
- R W Glaser, N. R. Stoll. Development under sterile conditions of the sheep stomach worm haemonchus contortus (nematoda). Science 1938 87(2255):259 – 260.
- J D Eikenberg, B M Davy. Prediabetes: A prevalent and treatable, but often unrecognized, clinical condition. J Acad Nutr Diet 2013 113(2):213 – 218.
- W R Rowley, C Bezold. Creating public awareness: State 2025 diabetes forecasts. Population health management 2012 15(4):194 – 200.
- I Hopper, B Billah, M Skiba, H Krum. Prevention of diabetes and reduction in major cardiovascular events in studies of subjects with prediabetes: Meta-analysis of randomised controlled clinical trials. Eur J Cardiovasc Prev Rehabil 2011 18(6):813 – 823.
- T Lancet. Type 2 diabetes--time to change our approach. The Lancet 2010 375(9733):2193.
- J G Dohlman, H De Loof, M Prabhakaran, W J Koopman, J P Segrest. Identification of peptide hormones of the amphipathic helix class using the helical hydrophobic moment algorithm. Proteins 1989 6(1):61 – 69.
- J Tuomilehto, J Lindström, J G Eriksson, T T Valle, H Hämäläinen, P Ilanne-Parikka, S Keinänen-Kiukaanniemi, M Laakso, A Louheranta, M Rastas, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine 2001 344(18):1343 – 1350.
- K Khavandi, H Amer, J Brownrigg, B Ibrahim. Strategies for preventing type 2 diabetes: An update for clinicians. Therapeutic advances in chronic disease 2013.
- Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010 Oct 22;8:29.
- Centers for Disease Control and Prevention (CDC). Awareness of prediabetes--United States, 2005-2010. MMWR Morb Mortal Wkly Rep. 2013 Mar 22;62(11):209-12.
- Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.
Image thanks to feverpitched via 123rf. Image has been modified.
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How to Prevent Prediabetes from Turning into Diabetes
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Content URLDoctor's Note
I often hear the diet and exercise intervention described as 60% effective. That’s still nearly twice as effective as the drug, but that other study really showed it may be more like 100% in people who actually do it. So is diet and exercise 100% effective or only 60% effective? On a population scale, since so many people won’t actually do it, it may only be 60% effective. But on an individual level, if you want to know what are the chances you won’t get diabetes if you change your lifestyle, then the 100% answer is more accurate. Lifestyle interventions only work when we do them. Kale is only healthy if it actually gets into our mouth. It’s not healthy just sitting on the shelf.
How about preventing prediabetes in the first place? See Preventing Prediabetes By Eating More and my next video How to Prevent Prediabetes in Children.
Some things we may want to avoid can be found in my videos Eggs and Diabetes and Fish and Diabetes.
And what if we already have the disease? See Diabetics Should Take Their Pulses and my new live presentation From Table to Able: Combating Disabling Diseases with Diet.
What if you don’t have time for exercise? Check out Standing Up for Your Health.
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