Lifestyle changes such as diet and exercise are more effective than medication at preventing a condition that can be a precursor to diabetes, a study published in the journal Annals of Internal Medicine found.
The study, examines metabolic syndrome, a combination of conditions such as obesity, high cholesterol, high blood pressure, and high blood sugar, which puts people at an increased risk for diabetes and heart disease.
Researchers wanted to see whether intervention could decrease the incidence of metabolic syndrome, either by preventing its development or by resolving it once it has already been diagnosed, thereby cutting the risk of diabetes and heart disease. To do so, they followed 3,234 people who were involved in the Diabetes Prevention Program. All had yet to develop diabetes but had high blood sugar levels and a body mass index of at least 24, which is on the high side of normal.
Participants were randomly assigned to one of three courses of treatment and followed for an average of three years. In one group, participants took the anti-diabetes medication metformin twice a day; in another, they took a placebo (a pill with no active ingredients); in the third, they adopted lifestyle changes such as diet and exercise designed to help them lose 7% of their body weight and maintain the weight loss.
At the start of the study, 53% of the participants had been diagnosed with metabolic syndrome, which was a surprisingly low number considering the participants were selected based on their apparent risk of diabetes. Metabolic syndrome was defined in the study as three or more of the following conditions: a waist circumference of more than 102 cm for men or 88 cm for women; blood triglyceride levels greater than 1.7 mmol/L; HDL, or "good" cholesterol, of less than 1.03 mmol/L for men and 1.3 mmol/L for women; blood pressure of 130/85 mm Hg or higher; and fasting blood sugar of 6.2 mmol/L or higher.
When the study began, there was almost no difference in the incidence of metabolic syndrome between the groups. But after three years of treatment, 43% of participants in the lifestyle group had metabolic syndrome, down from 51%; 55% of participants in the metformin group had metabolic syndrome, compared to 54% at the start; and 61% in the placebo group had metabolic syndrome, up from 55%. Compared to those in the placebo group, the participants that made lifestyle changes had a 41% lower risk of developing metabolic syndrome and a 29% lower risk than the metformin group. But metformin still showed an advantage over the placebo, with users showing a 17% lower risk of developing metabolic syndrome.
Researchers say these results demonstrate "the dramatic effect of lifestyle intervention" both for people at risk of developing metabolic syndrome and for people who already have it. They say the evidence points to this risk reduction as being linked to decreases in weight circumference and blood pressure brought on by diet and exercise, rather than to improved cholesterol levels.
While the study showed lifestyle changes to have the advantage over metformin, the researchers say it's possible that the two together could have an even greater effect at preventing metabolic syndrome.
"I think that this is an unanswered question at the moment," the lead author, Dr. Trevor Orchard, is quoted as saying in the e-newsletter heartwire. "Intuitively, we would think that there would be some additive benefit, but we can't draw that conclusion with certainty. Generally, we would think that they would be additive because they are working slightly differently - metformin works (by controlling blood sugar) whereas lifestyle has broader effects."
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