Nutritional Intervention to Prevent Type 2 Diabetes in Overweight Obese Subjects

Because much of the risk of developing type 2 diabetes is attributable to obesity,10 maintenance of a healthy body weight is strongly recommended as a means of preventing this disease. The relationship between glycemic index and glycemic load and the development of type 2 diabetes remains unclear at this time.9

Studies have been initiated in the last decade to determine the feasibility and benefit of various strategies to prevent or delay the onset of type 2 diabetes. A majority of subjects included in these trials were overweight/obese and had impaired glucose tolerance. In well-controlled studies that included a lifestyle intervention arm, substantial efforts were necessary to achieve only modest changes in weight and exercise, but those changes were sufficient to achieve an important reduction in the incidence of diabetes (58% in both the Finnish Diabetes Prevention Study and the US Diabetes Prevention Program). In the Finnish Diabetes Prevention Study,11 weight loss average 4.6kg at 1 year,3.8kg after 2 years,and 2.3kg after 5 years. In this study, there was a direct relationship between adherence to the lifestyle intervention and the reduced incidence of diabetes. In the Diabetes Prevention Program, the lifestyle group lost about 6kg at 2 years and 4.5kg at 3 years. A low-fat diet (<25% fat) was initially recommended.12 If reducing fat did not produce weight loss to goal (reduction of 7% of initial body weight), calorie restriction was also recommended and the total calorie intake was reduced to 1200-2000kcal/day according to initial body weight. The greater benefit of weight loss and physical activity with lifestyle change as compared to pharmacological intervention (relative risk reduction of 31% with metformin as compared to 58% with diet plus exercise in the Diabetes Prevention Program) strongly suggests that lifestyle modifications should be the first choice to prevent or delay diabetes. Modest weight loss (5-10% of body weight) and modest physical activity (30min daily) are the recommended goals. Because this intervention not only has been shown to prevent or delay diabetes, but also has a variety of other benefits, healthcare providers should urge all overweight and sedentary individ uals to adopt these changes, and such recommendations should be made at every opportunity.

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