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 The Community Preventive Services Task Force, an independent, unpaid
group of public health and prevention experts who develop
recommendations for community health, commissioned a review of 53
studies describing 66 combined diet and physical activity promotion
programs. The studies were done between 1991 and 2015.
The Task Force found strong evidence that these programs are
effective at reducing the number of new cases of diabetes, according
to a report in Annals of Internal Medicine.
“If you exercise and eat better, you’ll reduce your risk of
developing diabetes,” said Dr. Patrick L. Remington, coauthor of the
recommendation statement on behalf of the Task Force. “But if you
simply tell somebody to eat better and exercise, that does not
work.”
The diet and exercise promotion programs included providers or
trained laypeople working directly with participants for at least
three months, providing counseling, coaching and support over
multiple sessions.
Some also included specialists like nutritionists, physiotherapists,
individually tailored diet and exercise programs and specific
weight-loss goals.
The programs were targeted to teens and adults with “pre-diabetes,”
marked by elevated blood sugar levels that were not yet high enough
to be diagnosed with type 2 diabetes.
“In general, people who may be at increased risk for diabetes (both
adults and children) include those who are overweight or obese and
those who have a sedentary lifestyle,” Dr. Ethan Balk of Brown
University in Providence, Rhode Island, lead author of the evidence
review, told Reuters Health by email.
The review found that community-based programs helped improve weight
loss, lower blood sugar and reduce the risk for a later diabetes
diagnosis. Some also reduced blood sugar and improved cholesterol
markers, and none reported any long-term harms related to the
programs.
In an economic assessment, the Task Force also found that these
programs are cost-effective. Half of participants paid less than
$653 to take part, and costs were lower for group-based or
primary-care based programs.
“This is more cost effective than most of what we do in medicine,
but not cost saving, it does cost something,” Remington said by
phone. “But the return for those costs are many years of healthy
life gained, so we consider it cost effective.”
Gyms and health clubs already offer these types of programs for a
modest fee, he said.
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It’s “shocking,” he added, “that we are not doing it as a routine
part of the health care system. We’ve designed a healthcare system
to treat sick people, not to prevent disease.”
The first step may be a change in providers’ attitudes, he said,
noting that many doctors do not believe that diabetes can be
prevented through lifestyle changes.
“I think that the medical community has been so influenced by long
term secular trends that they’ve lost confidence in the individual
to treat themselves through lifestyle changes,” he said.
Then the insurance and outreach system needs to change, and training
laypeople or nonphysician specialists to provide these programs
should increase, he said.
“The (Affordable Care Act) doesn’t really cover these type of
intense prevention programs,” Remington said. “Generally we’ve left
people alone with advice.”
There are National Diabetes Prevention Program resources in every
state, and the Centers for Disease Control and Prevention has a
registry of recognized programs and a “Find a program near you”
function (link here: http://1.usa.gov/1vj7p00), Balk said.
SOURCE: http://bit.ly/1M6ih8z, http://bit.ly/1HrtBWf and http://bit.ly/1gxcvQh
Annals of Internal Medicine, July 13, 2015.
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