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Johns Hopkins Medicine Summary: People with pre-diabetes who lose roughly 10 percent of their body weight within six months of diagnosis dramatically reduce their risk of developing type 2 diabetes over the next three years, according to new research. Share: FULL STORY People with pre-diabetes who lose roughly 10 percent of their body weight within six months of diagnosis dramatically reduce their risk of developing type 2 diabetes over the next three years, according to results of research led by Johns Hopkins scientists.
Substantial weight loss in the short term clearly should go a long way toward preventing diabetes. Uncontrolled diabetes -- marked by excess sugar in the blood -- can lead to eye, kidney and nerve damage, as well as cardiovascular disease. The new research suggests that if people with pre-diabetes don't lose enough weight in those first months, physicians may want to consider more aggressive treatment, such as adding a medication to push blood sugar levels lower.
CAN is strongly associated with increased mortality, and in some studies with morbidity of vascular complications, such as stroke, coronary artery disease and myocardial infarction. At the early stages, CAN can be subclinical and it becomes clinically evident as the disease progresses. Subclinically, the disease is defined by cardiovascular reflex testing, which may have prognostic implications. Clinically, the impairment in autonomic function is associated with resting tachycardia, exercise intolerance, orthostatic hypotension, syncope, intraoperative cardiovascular instability, silent myocardial infarction and ischemia, and increased mortality. Although very common and serious, CAN is a frequently overlooked complication of diabetes.
A report on the research is published online today in the Journal of General Internal Medicine. Maruthur and her colleagues based their conclusions on analysis of data from the Diabetes Prevention Program DPPthe largest diabetes prevention study in the United States. Overweight, hyperglycemic people were recruited between and and followed for an average of 3.
More than 3, participants at 27 academic medical centers were assigned at random either to receive an intense lifestyle intervention, doses of the diabetes drug metformin designed to reduce blood glucose sugar levels, or a placebo.
Maruthur and her colleagues searched the study information for links among short-term weight loss, reduction of blood glucose levels and impact on the longer-term risk of developing diabetes. Although not all people with pre-diabetes develop full-blown type 2 disease, without intervention the risk of getting it within 10 years is substantially increased and damage to health may already have begun.
The good news, Maruthur says, is that studies like hers show that the progression from pre-diabetes to type 2 diabetes is not inevitable and lifestyle changes can bring blood sugar levels back to normal.
Participants in the lifestyle arm of the DPP were advised about better eating habits, directed to exercise minutes a week, and given one-on-one counseling for the first six months and group counseling thereafter. Researchers found that those in the lifestyle intervention arm who lost 10 percent or more of their body weight had an 85 percent reduction in risk of developing diabetes within three years.
Even more moderate weight loss showed positive effects. Those who lost 5 to 7 percent of their body weight reduced their risk of developing diabetes by 54 percent three years later.
This discovery could lead to a test that would help doctors identify patients at greatest risk and help them potentially avert the disease through interventions including diet and exercise. The research was led by Michael Wheeler, a professor of physiology at U of T's Faculty of Medicine, in collaboration with Hannes Röst, an assistant professor of molecular genetics and computer science at the Donnelly Centre for Cellular and Biomolecular Research, Feihan Dai, a research scientist of physiology and Erica Gunderson, a research scientist at the Kaiser Permanente Division of Research in Northern California. Mi Lai, a post-doctoral fellow in Wheeler's group performed much of the analyses.
Those who were given metformin, a drug that prevents the liver from producing too much glucose, did not lose significant amounts of weight on average. But those whose blood sugar levels were significantly lowered in six months of do diabetes cause heart problems the medication saw their future risk of developing diabetes fall as well.
Understanding Heart Failure in Diabetes
The lowest risk, Maruthur says, occurred in patients who lost weight and also lowered the amount of glucose in their blood, as measured by a blood test taken after fasting.
When blood tests indicate pre-diabetes, doctors like Maruthur often discuss with their patients the changes they can make to hopefully stave off type 2 diabetes. The new research suggests just how valuable -- and potentially cost-effective -- such interventions could be, she says.
Other Johns Hopkins researchers involved in the study include Frederick L. Brancati, M. Clark, M. Note: Content may be edited for style and length. Journal Reference: Nisa M. Maruthur, Yong Ma, Linda M. Delahanty, Julie A. Nelson, Vanita Aroda, Do diabetes cause heart problems H.
White, David Marrero, Frederick L. Brancati, Jeanne M.