Lifestyle Modification vs. Medication for Sustainable Diabetes Prevention

by Ashley Jordan Ferira, PhD, RDN

The global burden of diabetes is staggering, with an estimated 422 million adults living with the chronic disease.¹ This prevalence has almost doubled since 1980 alongside the rise in obesity and has been dubbed the “diabesity” phenomenon.¹ Diabetes and its myriad comorbidities (heart attack, stroke, kidney disease, nerve damage, limb amputation, vision loss, and pregnancy complications) translate into substantial economic losses to the person affected by the disease, health systems and national economies.¹

Effective diabetes prevention methods that are sustainable over the long-term are imperative to attenuate global diabetes morbidity and mortality. An Emory University study conducted a systematic review and meta-analysis to quantify long-term effects and sustainability of diabetes prevention strategies on diabetes incidence.²

Forty-three randomized clinical trials (RCT) with a duration greater than 6 months (range: 0.5-6.3 years) evaluated diabetes prevention using lifestyle modification (LSM) (i.e. weight loss) and/or medication interventions (insulin-sensitizing agents) in adults at risk for diabetes.² The 43 RCTs included over 49,000 participants (48% men) with an average age of 57. The RCT intervention type breakdown included: 19 medication, 19 LSM, and 5 combining medications with LSM.²

Efficacy of LSM vs. medication interventions for diabetes prevention:²

• LSM RCTs achieved a 39% reduced risk for diabetes incidence, while medication RCTs yielded a 36% risk reduction

Sustainability of LSM vs. medication interventions for diabetes prevention:²

• Medication trials failed to demonstrate sustained diabetes risk reductions
• LSM studies maintained a statistically-significant and clinically relevant 28% relative risk reduction during the follow-up period (range: 5.7–9.4 years)

Although both LSM and medications successfully reduced diabetes incidence in adults at risk for diabetes, the effectiveness of medications was temporary, while the lifestyle modification effects were sustained over years. Future research should investigate how follow-up interventions can be leveraged to preserve the initial LSM intervention success.

Why is this Clinically Relevant?

• Global diabetes prevalence has doubled over the past 40 years
• Effective and sustainable diabetes prevention methods are critical to reduce healthcare utilization and improve outcomes
• For diabetes prevention clinicians should recommend lifestyle modification interventions with focus on weight loss over medications²

Link to abstract

Citations

1. WHO. Global Report on Diabetes. 2016. http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf. Accessed February 14, 2018.
2. Haw JS, Galaviz KI, Straus AN, et al. Long-term sustainability of diabetes prevention approaches: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med. 2017;177(12):1808-1817.