An intensive aerobic exercise program and dietary intervention can not only improve glycemic control over standard care in individuals with type 2 diabetes but also reduce the need for glucose-lowering medication, the results of a randomized trial indicate.
Mathias Ried-Larsen, PhD, Center of Inflammation and Metabolism, Rigshospitalet, University of Copenhagen, Denmark, and colleagues found that, as well as having small improvements in HbA1c levels, almost three-quarters of patients assigned to an intensive lifestyle intervention could reduce their diabetes medication usage.
The research was published in the August 15 issue of the Journal of the American Medical Association.
The team writes: “The main finding was that an intensive lifestyle intervention was nonequivalent compared with standard care in relation to maintaining glycemic control, with the modest reduction in HbA1c favoring the lifestyle group.”
They add: “Further research is needed to assess superiority, as well as generalizability and durability of findings.”
The results are in line with those from the Look AHEAD study, which, as reported by Medscape Medical News, showed that an intensive lifestyle-intervention program aimed at achieving and maintaining weight loss and fitness achieved significant improvements in blood pressure, glycemic control, and some lipid measures over 4 years.
However, almost 10 times as many patients in the current study were able to reduce their usage of glucose-lowering medications than could in Look AHEAD.
“This may be due to several factors, including different levels of supervised exercise and total exercise volume (duration, frequency, and intensity), which in this study far exceeded what was implemented in the Look AHEAD study,” the researchers say.
“The use of drug-assisted weight loss in Look AHEAD also differed markedly from this study and may limit the true effect of lifestyle intervention.”
Intensive Intervention Drives Changes Consistent With Benefit
The objective of the study was to test whether an intensive lifestyle intervention results in equivalent glycemic control compared with standard care and, secondarily, leads to a reduction in glucose-lowering medication in participants with type 2 diabetes.
The study randomized 98 adults with non–insulin-dependent type 2 diabetesdiagnosed less than 10 years previously in a 2:1 fashion, stratified by sex, to either the lifestyle intervention alongside standard care (n = 64) or just standard care (n = 34).
The lifestyle intervention comprised five to six weekly aerobic training sessions of 30 to 60 minutes, of which two to three were combined with resistance training, together with dietary plans aiming at a target body mass index of ≤ 25 kg/m2. Standard care consisted of individual counseling and standardized, target-driven medical therapy.
The patients, who had a mean age of 54.6 years and baseline HbA1c of 6.7% and of whom 48% were women, were followed up for 12 months, with 93 individuals completing the study.
In the intensive-lifestyle group, the mean HbA1c decreased from 6.65% at baseline to 6.34% at 12 months, compared with a reduction from 6.74% to 6.66% in the standard-care group, representing a mean between-group difference in change of -0.26% (95% CI, −0.52% to −0.01%).
The difference in change in HbA1c levels during follow-up was not within the equivalence margin of ±0.4%, and therefore the criteria for equivalence in glycemic control was not met on the intention-to-treat analysis (P = .15). The results on the per-protocol analysis were similar, with the equivalence criteria again not met (P = .18).
The results showed that 47 (73.5%) of patients in the lifestyle group were able to reduce their glucose-lowering medications vs nine (26.4%) in the standard-care group, at a risk difference of 47.1% and a number needed to treat of 2.1.
There were 32 adverse events in the lifestyle group, the most common being any musculoskeletal pain or discomfort (14 events) and mild hypoglycemia (eight events), “which may be ascribed to higher susceptibility in this group in relation to, for example, mild hypoglycemia because of the combination of lifestyle and medical therapy,” the authors suggest, noting there were just five adverse events in the standard-care group.
In the intensive-lifestyle group 82% of the patients completed the prescribed exercise sessions, while attendance at the individual and dietary group sessions was 78% during follow-up.
“Among adults with type 2 diabetes diagnosed for less than 10 years, a lifestyle intervention compared with standard care resulted in a change in glycemic control that did not reach the criterion for equivalence but was in a direction consistent with benefit,” the authors conclude.