Diabetes cure is a mystery, but prevention isn't

Experts have yet to figure out how to cure people of type 2 diabetes, but years ago they learned to do something that should be regarded as having equal or greater value: how to prevent it.

The key to success was designed by University of Pittsburgh researchers, who led the local arm of the landmark multicenter study called the Diabetes Prevention Program that proved its worth so great the trial ended a year early.

It boils down to what has become a mantra for good health -- eat properly and exercise regularly.

The prevention program demonstrated that "you could delay or prevent the development of diabetes by 58 percent with a lifestyle intervention," said investigator Dr. Trevor Orchard, an epidemiologist at Pitt's Graduate School of Public Health.

More than 3,000 people, including about 150 from the Pittsburgh area, participated in the 27-site trial. All were overweight and had sugar-regulating problems likely to worsen into diabetes.

The participants were randomly assigned either to take a placebo pill, to be treated with the drug metformin, or to go through an intensive program to modify their eating and exercise habits with the goal of losing 7 percent of their starting body weight.

John Held, 76, of Whitehall, was one of the volunteers. His sugar level was slightly elevated, but he carried some extra pounds and his father and other relatives on his father's side had diabetes, putting him at increased risk.

He'd hoped to get into the diet and exercise arm of the test because, he said, he "really wanted to lose weight." But he was assigned to take pills, and he diligently did so.

Over a three-year period, 4.8 percent of the lifestyle modification group, 7.8 percent of the metformin group and 11 percent of the placebo group developed diabetes, Dr. Orchard said.

The dramatic findings were published in the Feb. 7, 2002 issue of the New England Journal of Medicine.

Participants in the metformin and placebo groups were informed of the results, and given the chance to go through the diet and exercise counseling program. It turned out that Mr. Held had been taking a placebo during his time in the study, so he grabbed the opportunity he wanted from the beginning.

During the 16-week lifestyle program, he dropped 25 pounds, which he suspects may have been too much, too soon. He had to buy new clothes because his old ones no longer fit, and his friends worried that he looked sick. But he stuck with it, and still does.

Even now, "I record everything I eat every day," Mr. Held said. "It really is almost like an obsession."

At the end of the week, he calculates his average total daily calories. He used to do that in notebooks, but now he's got a software program to make it simpler. His wife saves nutritional information from the products she uses so he can enter carbohydrate content and other factors into the database to get a calorie count.

For the exercise component, Mr. Held was given a pedometer and instructed to try to walk 50,000 steps per week, or about 7,000 per day. When he plays golf, he sometimes hits 18,000 in a single outing, he said. He also takes weekly tap dance classes, which he does more for fun than exercise.

Mr. Held doesn't have type 2 diabetes yet, and his blood sugar levels have pretty much stayed steady since he first entered the study almost a decade ago.

He said his wife decided to change her eating habits when he did, even though she didn't have his diabetes risk factors, such as a family history of the condition.

"She lost weight and she looks really good," Mr. Held said.<


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