Combined Diet and Physical Activity Program Effective Against Diabetes

According to the World Health Organization, almost 90% of people with diabetes around the world have type 2 diabetes. This type of diabetes is commonly the result of excess of body weight and lack of physical activity. Asystematic reviewperformed by theCommunity Preventive Services Task Forceshowed that by implementing a combined diet and physical activity program, people with type 2 diabetes can see normoglycemic levels and reduce cardiovascular disease risk factors such as high blood pressure, high cholesterol levels, excess body weight, and suboptimal blood glucose levels.

TheTask Forcereviewed 53 studies which combined, evaluated a total of 66 different programs. The programs varied in the number of sessions (median 15 sessions), program length (median 12 months), and diet and exercise program delivery (internet only, or combined, in-person, individual, and group sessions). The programs were led by a variety of trained specialists including diet counselors, dietitians, exercise counselors, physical trainers and physicians or psychologists. The success of the programs was tracked using weight-loss, diet, and physical activity goals. The majority of the programs showed positive results leading to weight loss or reduced risk for diabetes, or both.

TheTask Forcehas used these results as evidence for recommendations on community-and system-based interventions. These programs provide success in weight loss and reduce diabetes risks for patients, and were economically cost-effective according to the incremental cost effectiveness ratio (ICER) from a health system perspective. Seventeen studies reported other benefits of the programs, such as reduced systolic and diastolic blood pressures and improved lipid levels in participants.

There are a number of organizations that have implemented diet and exercise programs, nationwide. The Centers for Disease Control and Prevention established the National Diabetes Prevention Program (DPP) to coordinate lifestyle change programs to prevent or delay type 2 diabetes. The success of the DPP program influenced other prevention programs. One in particular, designed similarly to the DPP, was through the Montana Cardiovascular Disease and Diabetes Prevention Program, and has shown success in having 45% of those who completed the program achieved their weight-loss goal of 7%. The YMCA also adapted the DPP study program and provided a lower-cost program with group sessions, including 16 weekly core sessions and 8 maintenance monthly follow-up sessions. This program reached 46 communities in 23 states by 2012. Over 16,000 participants have been enrolled in similar programs over 750 community locations in 39 states.

With the rising numbers of patients diagnosed with type 2 diabetes, and the proven benefits of combined diet and exercise to reverse the incidence of type 2 diabetes, it is important for health care providers to be aware of the types of programs offered in their communities. Primary care providers are the initial resource for patients newly diagnosed with type 2 diabetes and so they are in the perfect position to provide their patients with information on how to participate in these programs.

This article was published in the 14 July 2015 issue ofAnnals of Internal Medicine.