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Lifestyle modification, metformin beneficial for patients with diabetes

CHICAGO — Intensive lifestyle interventions and metformin therapy have had significant success in treating type 2 diabetes and should both be considered when deciding on prevention and treatment, according to a presentation at the Cardiometabolic Health Congress.

“Both approaches should be used to prevent diabetes and I think that brings us into the whole discussion of how we fit lifestyle interventions into the use of medications,” Edward S. Horton, MD, professor of medicine at the Harvard Medical School and senior investigator at the Joslin Diabetes Center, said during his presentation. “We know that we have many, many very effective classes of medications to use, but don't forget the importance of incorporating lifestyle into your treatment plans.”

Results of the Diabetes Prevention Program (1996-2001) showed that 38% of patients assigned an intensive lifestyle intervention had a reversal of the metabolic syndrome at 3.2 years, compared with 23% of those assigned metformin and 18% of those assigned placebo.

“Really, in some ways the effects of the lifestyle program not only reduce the problems of these findings, but also there was a decrease in the necessity for the medication use in those patients,” Horton said. “We thought that the changes correlated mainly with weight loss and not in the physical activity measurements.”

Horton also highlighted the findings of the Look AHEAD trial that compared intensive lifestyle intervention with diabetes support and education. Among the intensive lifestyle group (n = 2,570; 59% women; 37% minorities; mean age, 59 years), participants ate calorie-restricted diets that included meal replacements and menu plans and had a gradual increase in exercise up to 175 minutes per week or approximately 10,000 steps (5 miles) per day.

In the diabetes education and support cohort (n = 2,575; 60% women; 37% minorities; mean age, 59 years), individuals participated in three to four meetings per year to promote retention and discuss health education topics, diet, exercise and social support.

According to the presentation, the 10-year results of the Look AHEAD trial found that compared with diabetes education and support, intensive lifestyle intervention was associated with:

better weight losses throughout the trial;greater improvements in fitness;reduced glycated hemoglobin and need for insulin;sustained improvements in BP and HDL; andless improvement in LDL but less statin use.

However, the 10-year results of the trial found no significant difference between the groups on CV events, according to the presentation.

“In the early days, when I first started working in the field of diabetes, there was virtually no attention paid to cardiovascular risk in the diabetic population,” Horton said during the presentation. “It was really all about microvascular complications. Then the Framingham study was really one of the driving factors that got us interested in diabetes as a cardiovascular-associated condition.” – by Scott Buzby


Horton ES. Lifestyle Interventions for Prevention of Diabetes and the Metabolic Syndrome. Presented at: Cardiometabolic Health Congress; Oct. 10-13, 2019; Chicago.

Diabetes Prevention Program Research Group. N Engl J Med. 2002;doi:10.1056/NEJMoa012512.

Look AHEAD Research Group. N Engl J Med. 2013;doi:10.1056/NEJMoa1212914.

Disclosure: Horton reports no relevant financial disclosures.

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