March 19--A hands-on approach to diabetes prevention enabled local overweight or obese
residents do a better job with losing and keeping off extra weight, according
to a Wake Forest Baptist Medical Center study.
Researchers examined 301 Forsyth County participants over 24 months who
had been diagnosed with elevated fasting blood glucose, a common indicator of
pre-diabetes. The study was conducted between 2007 and 2011, with the
participants representing the racial composition of the county's population,
Wake Forest Baptist officials said.
The study was published in Monday's issue of the American Journal of
Preventive Medicine.
"Many previous studies have shown that people can lose weight for six
months, but maintaining those changes, particularly metabolic changes, over
time is the real challenge," said Jeff Katula, the study's lead author and
joint assistant professor of epidemiology and prevention at Wake Forest
Baptist.
Participants were assigned randomly to either a group-based lifestyle
weight-loss intervention led by community health workers in parks and
recreation center settings, or an enhanced version of the standard doctor's
advice to a patient on losing weight and exercising. The enhanced part was
participants having two meetings with a registered dietitian and access to
monthly newsletters.
All participants were assessed every six months for fasting blood
glucose, insulin, insulin resistance, body weight, body mass index and waist
circumference.
What the researchers found is that the lifestyle weight-loss intervention
group had a larger decrease in weight in the first year and kept more of the
weight off during the second year. After 24 months, nearly 47 percent of the
lifestyle weight-loss intervention participants had lost at least 5 percent of
their initial body weight, while just 15 percent of the enhanced standard care
participants achieved those results.
Also, researchers found that the "significant reductions" in body weight,
body mass index, waist circumference, fasting blood glucose, insulin and
insulin resistance achieved during the first year were maintained in the
second year.
Wake Forest Baptist said its study is the largest program to successfully
replicate the results achieved by the Diabetes Prevention Project, a research
study led by the National Institutes of Health. That study demonstrated that
lifestyle weight-loss interventions can reduce the incidence of diabetes by 58
percent.
"We wanted to take this intervention out to people in the community
rather than having them have to come to us in a clinical setting," Katula
said. "Given the high prevalence of obesity and metabolic syndrome and risk
for diabetes, our study shows we can provide an effective program in a
community setting."
Wake Forest Baptist said that almost 26 million people in the U.S. have
diabetes and another 79 million adults have pre-diabetes, a condition in which
blood glucose levels are higher than normal but not yet high enough to be
diagnosed as diabetes.
It is unclear whether this type of intervention can be implemented
effectively in varying geographic locations involving various racial
distributions and/or in rural settings, Katula said.
The project was supported by a grant from the National Institute of
Diabetes and Digestive and Kidney Diseases.
In March 2012, two studies -- not by Wake Forest Baptist -- determined
that weight-loss surgery can reverse and possibly cure diabetes, and doctors
say the operation should be offered sooner to more people with the disease,
not just as a last resort.
The two studies are the first to compare stomach-reducing operations to
medicines alone for "diabesity" -- Type 2 diabetes brought on by obesity. Both
studies found that surgery helped far more patients achieve normal blood-sugar
levels than did medicines alone.
The results were dramatic: Some people were able to stop taking insulin
as soon as three days after their surgeries. Cholesterol and other heart risk
factors also greatly improved.
"It is a major advance," said John Buse of UNC Chapel Hill, a leading
diabetes expert who had no role in the studies. Buse said he often recommends
surgery to patients who are obese and cannot control their blood sugar through
medications, but many are leery of it.
rcraver@wsjournal.com
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The Associated Press contributed to this article.
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