Saturday, October 27, 2012


There is a study call the LOOK AHEAD ( Action for Health Diabetes ), funded by the National Institute for Health, that try to look into this question. They studied 5,145 diabetics, who were all overweight ( average BMI was about 25 Kg / M2. They divided them into 2 arms. One arm, underwent intensive lifestyle modification, with close monitoring on exercise regimes, and also counselling by dietician. The other arm had just the usual clinic counselling for diabetics. The primary endpoint was death, non fatal MI, non fatal strokes and also hospitalisation.
After 4 years and after 11 years, the study never met the endpoint. The study was prematurely concluded. I guess they ran out of funding, as Obama-land is in recession.
However, there were significant improvements in weight reduction, exercise fitness, HbA1c levels, HDL-C, Triglycerides, blood pressure, in the treatment arm.

What this study thought me was that it was important to exercise, and diet. We will all be healthier. But it will take much bigger numbers to reduce the hard endpoints in diabetes management. We may be able, by lifestyle modification to reduce micro-vascular complications, but it will take much more to reduce macro-vascular complications.

It was important to note also, that those who lost weight at year 4, gain some of it back at year 11. Telling me that intensive regimes are difficult to sustain. I always advise my patients that in life regimes must be sustainable, and also, everything in moderation, more so now that being intensive,helps, but not with the big points.

We should all have an exercise program, and diet program, but everything in moderation. Set yourself realistic goals, which are sustainable.

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