Lifestyle program boosts diabetes control in overweight Chinese

Medical Tribune March 2009 SFV
David Brill

An integrated lifestyle intervention program, including dietary supplements and meal replacements, can help overweight Chinese diabetics lose weight and improve glycemic control, a new study has shown.

Patients who followed the program for 24 weeks lost an average of 2.7 kg and saw their HbA1c drop by 0.8 percent compared to baseline (P<0.001).>

Such were the benefits of the intervention that 15 of the 100 type 2 diabetics who followed it had had their diabetes medication dosages reduced by the end of the trial, while a further seven stopped taking them altogether.

The results of the study, led by Dr. Jianqin Sun of Fudan University, Shanghai, were announced at a recent Singapore press conference and published in the Asia Pacific Journal of Clinical Nutrition. [2008; 17(3):514-24]

The intervention program included diabetes education, nutritional counseling, meal replacement with dietary supplements, and weekly progress reports with a physician and a dietician. It was compared in a randomized prospective trial against a simpler intervention comprising only education on diet and physical activity. Fifty patients were included in this reference group.

Professor William Garvey, a US diabetes expert who commented on the study, described the reduction in HbA1c as “very impressive” given that the intervention patients were already well-controlled, with an average HbA1c of 7.1 percent at baseline. He also noted that the potential to reduce or stop medications provides a good incentive for diabetic patients to lose weight, but stressed that these adjustments should only be made following proper consultation with a physician.

Dr. Kevin Tan, vice-president of the Diabetic Society of Singapore, said that the study demonstrates the viability of meal supplements as a therapy for diabetes, adding that this option should be explored for all patients who are overweight.

“Meal supplements or replacements have not been talked about much so a lot of doctors don’t think about them, but they do play a part in diabetes management in terms of helping to reduce calorie intake and helping patients to lose weight. If GPs realize that this can be part of their usual holistic diabetes care, along with the medications, exercise and weight control, then I think it will help to improve sugar control in their diabetic patients,” he said.

Participants in the study were all type 2 diabetics aged 18 to 70 with a BMI of 23 kg/m2 or above. The lifestyle intervention also significantly improved blood pressure (BP), with patients in this group recording average reductions of 7.5 mmHg for systolic BP and 3.4 mmHg for diastolic BP, at 24 weeks as compared to baseline. These reductions were significantly greater for the intervention group compared to the reference group.

The waist-to-hip ratio was also reduced among patients in the intervention group compared to those in the reference group.

“Dietary supplements are not the magic answer for everybody but they can be helpful in many patients,” said Garvey, who is based at the University of Alabama at Birmingham, US.

“If you have a patient who needs to lose weight and you feel that they need more structure in terms of their dietary plan – less guesswork and more clear-cut guidance in terms of what the diet will be from day to day – a meal replacement is a really good tool to use,” he said.

Garvey acknowledged that the short duration of the trial makes it hard to assess the long-term sustainability of the intervention, but added that the structured nature of the program teaches important behavioral modification skills which continue to be applicable beyond the trial setting.

The burden of type 2 diabetes in China is increasing rapidly, according to the study authors, who note that the prevalence among large city residents rose from 4.6 percent in 1995 to 6.4 percent in 2002. In Singapore the burden could be even higher, with data from the 2004 National Health Survey suggesting a diabetes prevalence of 8.2 percent among residents aged 18 to 69.

The trial by Sun et al. was funded by Abbott Laboratories, which manufactures the dietary supplement used in the study.