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Am Fam Physician. 2000;62(8):1877-1878

Lifestyle Modifications Can Prevent Onset of Type 2 Diabetes

(60th Annual Scientific Sessions of the American Diabetes Association) The incidence of type 2 diabetes mellitus (formerly called non–insulin-dependent diabetes mellitus) can be reduced by as much 58 percent through individualized intervention programs that encourage lifestyle modifications such as dietary changes and regular moderate exercise among patients at high risk for the disease. This is according to results of the Finnish Diabetes Prevention Study involving 523 high-risk patients who had impaired glucose tolerance, a state between “normal” and “diabetes,” in which the body is no longer using and/or secreting insulin properly. The average age of the patients was 55 years and the average body mass index was 31. Patients were enrolled between 1993 and 1998, with 265 patients randomized to the intervention group and 257 patients randomized to the control group. The intervention group received individual counseling on nutrition and exercise, including hour-long individual sessions with a dietitian seven times during the first year and every three months thereafter, and an exercise assessment and program plan. Patients in the intervention group also received either a one-year membership in a local health club or an exercise opportunity at a rehabilitation center, a nursing school facility or a sports institution. Patients in the control group received yearly meetings with a nutritionist and a physician and were given standard advice for the same type of dietary improvements and increased exercise as the patients in the intervention group. All subjects kept food and exercise journals. The cumulative incidence of diabetes after four years of the study was 22 percent (57 patients) in the control group and 10 percent (26 patients) in the intervention group. Reductions in the incidence of diabetes were similar among men and women. Patients in the control group lost an average of 4.2 kg (9.24 lb) during the first year of the study and 3.5 kg (7.7 lb) after two years. Patients in the control group lost only an average of 0.8 kg (1.76 lb) during the first year, which was maintained in the second year.—jaako tuomilehto, m.d., National Public Health Institute, Helsinki, Finland.

Efficacy of Metformin Is Similar in Children and Adults

(American Diabetes Association) Study results proved metformin (Glucophage) to be a safe and effective noninvasive, first-line antidiabetic therapy for children with type 2 diabetes mellitus (formerly called non–insulin-dependent diabetes mellitus) unmanaged by diet alone. The children also had similar tolerability, efficacy and side-effect results compared with adult patients who had type 2 diabetes and used metformin. Eighty-two pediatric patients (aged 10 to 16 years) with confirmed type 2 diabetes and a fasting plasma glucose (FPG) level greater than 126 mg per dL (7.0 mmol per L) but not greater than 240 mg per dL (13.3 mmol per L), glycosylated hemoglobin (HbA1c) levels greater than 7 percent, stimulated C-peptide levels greater than 1.5 ng per mL and a body mass index above the 50th percentile for their age were included in the double-blind, placebo-controlled trial. At baseline, mean FPG, HbA1c and body weight measures were 182 mg per dL (10.1 mmol per L), 8.6 percent and 92 kg (202 lb, 6 oz), respectively. The patients were randomized to receive placebo (40 patients) or metformin (42 patients), with a starting dosage of 500 mg twice daily and increasing to 1,000 mg twice daily over a two-week period unless limited by tolerability. Follow-up was conducted after 16 weeks unless discontinuation from double-blind treatment was necessary because of inadequate glycemic control. At the end of treatment, FPG was significantly lowered (-43 mg per dL [-2.4 mmol per L]) in patients receiving metformin compared with an increase of 21 mg per dL (1.2 mmol per L) in patients receiving placebo. HbA1c levels were also significantly lower in patients receiving metformin compared with patients receiving placebo (7.5 versus 8.6 percent, respectively). Metformin had a neutral effect on lipid levels and body weight. Adverse events were similar to those seen in adults receiving metformin, with gastrointestinal side effects being the most commonly reported.—kenneth jones, m.d., et al., University of California, San Diego School of Medicine, San Diego, California.

Glycemic Control Improves Quality of Life in Patients with Diabetes

(American Diabetes Association) A significant, positive association exists between improved glycemic control, even over a short time period, and improved quality of life in patients with type 2 diabetes mellitus (formerly called non–insulin-dependent diabetes mellitus) and that association is consistent across various cultural and linguistic boundaries. This conclusion is based on the results of a phase III randomized, double-blind, placebo-controlled 24-week clinical trial to evaluate the efficacy of various dosages of the investigational drug nateglinide (60, 120 or 180 mg) in reducing blood glucose levels. The study included 694 men and women (average age: 58 years) with type 2 diabetes from 62 clinical sites in nine countries. Eighty-seven percent of patients were white, 71 percent were married and 54 percent were college-educated and employed. Glucose levels, which were checked with glycosylated hemoglobin (HbA1c) blood tests, were higher than normal, 8.1 percent, at baseline. After six months, HbA1c levels for patients receiving any dosage level of nateglinide were reduced to 7.3 to 7.6 percent, compared with no change in patients receiving placebo. The most common improvements associated with glycemic control included the following: incidence of symptoms; general perceived health; vitality; mental acuity; emotional ties; psychologic well-being; overall quality of life; symptoms interfering with daily life; and symptoms causing distress. Patients whose HbA1c levels were worse at the conclusion of the study compared with baseline showed no improvement in any of the quality of life scales. Hospital or clinic visits, the need for general assistance and calls to the physician were also reduced in the patients receiving medication compared with the patients receiving placebo.—marcia a. testa, ph.d., et al, Harvard Medical School, Boston, Massachusetts

Test Strip Proves Effective, Less Painful Alternative to Fingerstick

(American Diabetes Association) According to results from two studies, the new ONETOUCH FastTake Test Strip, which allows patients with diabetes to test their blood glucose level using blood samples from their arm rather than from their finger, was considered significantly less painful than fingerstick testing and may result in improved patient compliance with the American Diabetes Association's recommendation of blood glucose testing as often as four times daily. The ONETOUCH FastTake Test Strip (which is a component of the ONETOUCH FastTake Blood Glucose Monitoring System) makes arm testing easier because it requires a 40 percent smaller blood sample than the fingerstick method (1.5 μL versus 2.5 μL) and it automatically drags the blood drop into the tip of the test strip on contact. The ONETOUCH FastTake Test Strip also supplies accurate test results in 15 seconds and features a 150-test memory and automatic 14-day average of blood glucose test results. Approximately 75 percent of the patients in each of the two studies found the test strip easier to use and less painful than the fingerstick method. The test strip tends to be less painful than the fingerstick method because the arm has fewer nerve endings. Researchers believe that providing patients with this alternative may encourage them to increase the frequency of their blood glucose testing above the current national average of slightly more than once a day. They also point out that regular testing can help patients with diabetes make the necessary adjustments to maintain better control of their blood glucose levels.—stuart brink, m.d., New England Diabetes and Endocrinology Center, Waltham, Massachusetts.

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