This was a significant study, as it showed that diet+lifestyle was superior to frontline pharmacotherapy for diabetes prevention. In the Diabetes Prevention Program, obese subjects with prediabetes were randomly assigned to an intervention of either metformin, diet+exercise, or placebo: diabetes prevention was 58% in the lifestyle group, compared to 31% in the metformin group (14). In the Finnish Diabetes Prevention Study, diabetes prevention of 58% at 3-years follow-up in prediabetic overweight subjects corresponded to an average weight loss of 3.5kg compared to 0.8kg in the control group (12 13). This may be the crux of diabetes prevention through weight loss. However, while diet and exercise may improve FPG and OGT without a change in BMI, one of the issues with progression from prediabetes is continued decline in pancreatic beta-cell function and insulin secretion (11). ![]() This is consistent with the positive impact that diet and physical activity have on the prediabetic state, improving FPG and OGT and reducing risk of progression by increasing glucose tolerance and tissue insulin sensitivity (10). The Indian Diabetes Prevention Programme trial found a diet and lifestyle intervention was successful in diabetes prevention over 2.5-years, in a population with a high prevalence of progression to diabetes, despite no change in BMI (9). The preventative effect of diet and lifestyle interventions independent of BMI has been found in other trials. What this indicates is that diet and exercise influence the underlying metabolic complications – like insulin resistance and glucose tolerance – which may not be reflected by changes in BMI alone. In the exercise-only group, 43% of achieved diabetes prevention compared to 72% of controls, despite losing exactly the same amount of weight as controls (8). Looking closer at the study, 38% of subjects in the diet-only group achieved diabetes prevention 6-years later compared to 60% in the control group, despite slightly more weight gain in the diet group (8). In the Da Qing Study, prediabetic subjects in diet-only, exercise-only, or diet+exercise groups were successful in diabetes prevention by 22-29% on average (8). There are 4 major trials across different populations showing diet and lifestyle interventions may be successful for diabetes prevention. Weight Loss for Prevention of Prediabetes Progression to Diabetes It is also relevant to potential diabetes prevention in already diagnosed subjects. This is relevant both to extant diabetes prevention, and prevention of progression from “prediabetes” – which refers to 3 states: isolated impaired fasting glucose, isolated impaired glucose tolerance, and both IFG and IGT together (7) – to diabetes. In parallel to this risk, weight loss may significantly improve diabetes prevention: a 5-10kg average weight loss is associated with a 50% reduction in risk (6). ![]() ![]() While this demonstrates that the underlying metabolic dysfunction is a primary issue, the risk is not wholly inseparable from weight, and overweight and obesity increase risk of diabetes by 3-fold and 7-fold, respectively (5). There is a clear association between Body Mass Index and risk for diabetes, but the risk is not exclusively linear: BMI varies greatly at time of diagnosis, which indicates that the risk is associated with underlying metabolic complications, including insulin resistance and decreased pancreatic beta-cell function (3).įor example, in metabolically healthy subjects who had the same BMI at baseline, those who progressed to diagnosis 13-years later displayed higher fasting blood glucose, postprandial glucose tolerance, and decreased insulin sensitivity at baseline (4). The Relationship Between Bodyweight and Risk for Diabetes The clear environmental determinants of diabetes risk and prevalence in turn point to the potential for diet and lifestyle interventions to be effective in diabetes prevention or remission. The population-based research showing a significant rise in diabetes prevalence over the past 50-years mirrors environmental changes in nutrition habits, food availability, diet composition, and population activity levels (2). In the epidemic of non-communicable diet and lifestyle disease, type-2 diabetes has emerged as a particular scourge: the leading cause of death under 60-years of age, and an annual cost of 263-billion dollars in North America in 2013 (1). This includes using the recommendations from our macro calculator.) ( Always consult your physician before starting a new diet.
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