"The groundwork of all happiness is health." - Leigh Hunt

New trial muddies the waters on food regimen, exercise and diabetes.

The long-awaited results of an almost 10-year trial exploring the consequences of food regimen and exercise changes in individuals with diabetes weren't what most individuals expected. The Look AHEAD trial found that intense efforts to shed pounds by eating less and exercising more didn't provide any greater protection against heart disease—a standard co-traveler with diabetes—than standard diabetes support and education. Some media reports suggest that weight reduction doesn't reduce the danger of heart disease in individuals with type 2 diabetes, but I feel it is a misinterpretation.

In the Look AHEAD trial, researchers recruited greater than 5,000 men and girls with type 2 diabetes. All were obese. Half were assigned to a program geared toward shedding pounds by exercising and cutting calories. People on this group were asked to eat between 1,200 and 1,800 calories a day and exercise a minimum of 175 minutes per week. Their goal was to lose a minimum of 7 percent of their starting weight and maintain that weight reduction. The other half of the volunteers met thrice a yr for group counseling sessions that focused on the importance of lifestyle changes equivalent to more exercise, higher food regimen, and more social support to regulate their diabetes.

Both groups lost weight and did an amazing job of keeping it off. Those within the acute change group lost barely more weight (about 18 kilos) than the comparison group (about 14 kilos). After about 10 years, the rates of heart attack, stroke, cardiovascular death, and hospitalization for chest pain were similar within the two groups.

The headline only tells a part of the story.

There are several ways to clarify why intensive intervention doesn't seem like higher than standard care, a minimum of for heart disease. Here's an “obvious”: Weight loss clearly helps lower blood sugar, however it may not play a big role in heart attack and stroke risk.

I feel a better have a look at the forward-looking participants, and other results, tells one other essential story:

  • Both groups lost weight at the tip of 9.6 years of the study. The mean difference between the 2 groups was 2.5% of initial weight. It is feasible that weight reduction is essential for type 2 diabetes and heart disease, but more weight reduction is required.
  • Fewer people within the intensive intervention group needed medication to lower blood pressure and cholesterol, perhaps because their food regimen and exercise did it for them. More people in the same old care group were treated with drugs which were shown to cut back the danger of heart attack and stroke.
  • The volunteers generally had their diabetes under control. A measure of diabetes control is a blood test called hemoglobin A1c. People with type 2 diabetes should aim for a reading of lower than 7.0. Those within the severe change group had a mean of seven.2. Those within the comparison group, 7.3. Lifestyle interventions could have greater advantages in individuals with poorly controlled diabetes.
  • People within the intensive lifestyle intervention group were instructed to eat a regular low-calorie food regimen that was relatively high in carbohydrates and low in fat. But such foods should not the perfect for cardiovascular health. Encouraging volunteers with acute conversion to adopt a Mediterranean-style food regimen could have benefited more.

Lifestyle still matters, so much

People with diabetes are two to 4 times more prone to have a heart attack or stroke than people without diabetes. And deaths from heart disease and stroke are the leading causes of death and disability in individuals with diabetes.

Lifestyle changes are emphasized because the mainstay of diabetes treatment, especially for individuals with type 2 diabetes. Getting more exercise, shedding pounds, and eating a healthy food regimen are clearly good for lowering blood sugar, which translates into advantages for all the body.

The results of the Look AHEAD trial don't contradict the worth of lifestyle changes. People on this group improved their blood sugar with less medication, saving $600 a yr. Those within the severe conversion group were 30 percent less prone to develop chronic kidney disease, a risk complication of diabetes. They also had fewer vision problems (diabetes is a number one explanation for vision loss), less depression, and reported feeling higher.

The Look Forward results reinforce to me that diabetes care must be individualized. It's not a one-size-fits-all recipe. It should transcend blood sugar control and weight reduction, and provides equal priority to stopping all complications that result from diabetes.