Landmark Studies in Diabetes Care
Written by Ask Physician
February 28, 2019
Dr. Rita Kalyani, MD, MHS
In the past 25 years, several large research studies in persons with prediabetes and diabetes have led to a great deal of important, scientifically supported information. These studies have shown how to effectively prevent diabetes and its complications and how, in some persons with diabetes at high risk for cardiovascular disease, less intensive targets for blood glucose control may be safer. Some of the most important findings in diabetes prevention and blood glucose control are summarized here. This list does not include all studies to date but reveals those that have arguably had the greatest impact on the current management of diabetes.
What You Need to Know
Studies on the Prevention of Diabetes
Da Qing Study: Chinese researchers randomly assigned 577 men and women with prediabetes to different diabetes prevention treatments from 1986 to 1992. They found that regular exercise and a healthy diet can reduce the risk of developing type 2 diabetes. People who modified their diet over an average period of 6 years had a 31% lower risk of diabetes, while those who adopted an exercise regimen had a 46% lower risk. People who embraced both diet and exercise lifestyle changes had a 42% lower risk compared to those who continued their usual diet and exercise patterns. The benefits of these lifestyle changes for preventing diabetes persisted up to 14 years later.
The Finnish Diabetes Prevention Study: In this study, Finnish researchers randomly assigned 522 overweight middle-aged adults with prediabetes to receive intensive dietary counseling along with regular exercise or continue their usual diet and exercise patterns from 1993 to 1998. After an average of 3 years, 11% of people in the intensive lifestyle group developed diabetes compared to 23% in the usual care group, representing a 58% reduction in the risk of diabetes. The benefits of these intensive lifestyle changes for preventing diabetes persisted up to 9 years later.
Diabetes Prevention Program (DPP): In this key U.S. study from 1996 to 2001 of 3,234 overweight middle-aged adults with prediabetes, each person was randomly assigned to either an intensive lifestyle change, metformin, or placebo pills. Over an average of 3 years, the study found that those assigned to the intensive lifestyle change, which included healthier eating (based on individualized daily calorie and dietary fat goals), regular exercise (a total of 150 minutes of moderate physical activity every week, such as brisk walking for 30 minutes every day, 5 days a week), and a goal of 7% weight loss (for example, in a person who weighs 200 pounds, this would correspond to a 14-pound weight loss), reduced their risk of developing type 2 diabetes by 58% compared to the placebo group. In comparison, metformin treatment reduced the onset of diabetes by 31%. The lifestyle changes were particularly effective in persons 60 years and over and lessened this age group’s risk of diabetes by 71%. The benefits of reducing the development of type 2 diabetes persisted for up to 15 years for both the lifestyle and metformin groups, supporting the importance of type 2 diabetes prevention.
Studies of type 1 diabetes have found no evidence that the early use of injected or oral insulin in people at high risk for the disease can prevent or delay its onset. Research on treatments that alter the immune system (immune-modulating therapies) to delay or prevent the development of type 1 diabetes is ongoing.
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