A joint symposium with the American Diabetes Association and The Lancet was held this morning at the Association’s Scientific Sessions. Two studies stood out when it came to focusing on routine diabetes screening and early intervention, especially in Europe where is not consistently or routinely employed.
Diet First, Then Exercise
One study, called the Early Activity in Diabetes Trial (ACTID), explored the benefit of adding exercise to diet changes when treating those newly diagnosed with type 2 diabetes. Conducted in the U.K., this study found that an intensive dietary intervention resulted in the same improvements as making changes in both diet and physical activity levels. (And by “improvements” they mean glycemic control, weight loss, cholesterol and triglyceride levels.)
Kind of surprising, isn’t it? We know that diet and exercise are essential parts of managing type 2 diabetes. Lead researcher Rob Andrews, MB, ChB, PhD, hypothesized that the reason the research didn’t show additional benefits when exercise was added was because people often make a trade, “If they go to the gym, then they feel as if they can have a treat. That could be why we saw no difference I the weight loss for the diet plus exercise group.”
So what can we take away from this? Changing your diet and incorporating an exercise routine can be overwhelming, time consuming and expensive. If you have recently been diagnosed with type 2 diabetes and have to make a choice between diet and exercise, you may want to talk to your health care team about focusing your efforts on changing your diet.
But what if you’ve had type 2 diabetes for some time? “Glycemic control gets worse over time,” said Andrews. “Adding exercise later might provide another boost in control whereas it wouldn’t early on.”
Intensive Treatment is at the Heart of Matters
The second study, the Anglo-Danish-Dutch study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION-Europe), screened people for type 2 diabetes in Denmark, the Netherlands and the U.K. They then placed participants who were diagnosed with type 2 diabetes in one of two groups: an intensive multifactorial treatment group or a routine care group.
Participants in the intensive treatment group were encouraged to make lifestyle changes (such as increasing physical activity level, changing diet and quitting smoking), aspirin treatment and intensive medication treatment for blood pressure, blood glucose and lipids.
Participants in the routine care group received no follow-up support and were told to follow national guidelines for lifestyle advice and medical treatment of blood pressure, blood glucose and lipids.
You would think that the people in the intensive treatment group had vastly better outcomes, right? Maybe that’s what everyone anticipated, too, but the research itself showed otherwise. Participants in the intensive treatment program had only modestly better improvements in cardiovascular risk factors compared to the participants in the routine care group.
One point that the researchers found remarkable was that the participants in the routine care group did so well. “Family physicians in the routine care group did a much better job than we expected,” said Torsten Louritzen, MD, chairman of the study’s steering committee. “Even in that group, there was a clinically significant reduction in blood pressure and cholesterol levels, and small reductions in blood glucose levels and weight were maintained over five years.”
The main take away is that conducting screenings in high risk individuals was associated with reductions in cardiovascular risk factors – the earlier you know, the more opportunity you have to keep your heart healthy. Screening for type 2 diabetes is not routine in Europe, but this study indicates that the benefit of early detection is enough reason to consider screening in the general population.