Preventing Progression From Impaired Glucose Tolerance to Diabetes

Allan S. Brett, MD

Journal Watch. 2006;5(10) 

Summary and Comment

Overweight patients with impaired glucose tolerance lowered their absolute 3-year risk for diabetes from about 35% to 15% by losing 5 kg.

Summary

In the Diabetes Prevention Program, an intensive lifestyle intervention for overweight patients with impaired glucose tolerance lowered the 3-year incidence of overt type 2 diabetes, compared with a control intervention (Journal Watch Feb 19 2002). In this additional analysis, researchers sought to determine which element of the lifestyle intervention (weight reduction, exercise, or reduction in dietary fat content) was most responsible for preventing progression to diabetes.

Of the 1079 participants in the intensive-lifestyle intervention group (mean baseline weight, 94 kg), 153 developed overt diabetes during a 3-year follow-up. In a multivariate analysis, weight loss clearly was the intervention most responsible for reducing progression to diabetes. Every kilogram of weight lost resulted in a relative risk reduction of 16%, after adjusting for exercise and diet composition. A 5-kg weight loss resulted in a relative risk reduction of 58%.

Comment

We frequently identify overweight and obese patients with impaired glucose tolerance but not overt diabetes. This study provides information that can help us to advise these patients about the benefits of weight reduction to prevent progression to diabetes: Patients similar to participants in this trial could reduce their absolute 3-year risk for diabetes from about 35% to 15% by losing 5 kg; risk would be reduced further by additional weight loss. These findings do not negate the role of exercise in weight loss; rather, they suggest that weight loss itself is the key factor, however one achieves it.

— Allan S. Brett, MD

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