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- December 1, 2008 |
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"Lifestyle Intervention"Dr. Robert Sherwin (biography)
English - 2003-08-28 - 54 minutes
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Summary :
Recorded during the 18th IDF Meeting, Paris: The rapid worsening of the diabetes epidemic in the United States can be largely attributed to the radical change in lifestyle in terms of diet and exercise in the last 50 years. Treatment of diabetes, however remains suboptimal. This leaves the question, should clinicians be attempting to prevent diabetes? Five criteria must be met if this is to be done, so that it should be an important health problem with a defined endpoint, have a safe and effective preventive method which is also not excessive in cost, and there must be benefits to intervening.
The DaQuing, Finnish and DPP Studies all showed a reduction in the appearance of diabetes by lifestyle interventions, by a factor of about 50%. This required a substantial amount of effort and motivation, and these changes have not been easy to maintain. Lifestyle intervention is the preferable way to prevent diabetes and its complications, but this may not be feasible or sustainable in many patients. Pharmacological interventions studied so far, such as metformin in the DPP Study seem to delay rather than prevent diabetes, but it remains to be seen whether the TZDs with their more robust effect can actually prevent the disease.
In this presentation we will review and discuss the results of the major lifestyle intervention studies, and where and how pharmacological intervention may be applied, in the delay and/or prevention of type 2 diabetes.
Learning objectives :
The participant will learn about the results of the recent lifestyle intervention studies, and get an idea of how to proceed in treatment based on this information:
o Substantial effort was necessary to achieve modest changes in body weight and activity in motivated patients.
o These changes had a significant impact on glycemia for at least 3 years.
o Success in meeting lifestyle intervention goals was associated with a lower incidence of diabetes.
The key issues in offering drug therapy if lifestyle intervention fails are:
o safety
o specific CVD benefit
o duration of delay
o cost effectiveness
Bibliographic references :
The Prevention or Delay of Type 2 Diabetes
American Diabetes Association National Institute of Diabetes, Digestive and Kidney Diseases
http://care.diabetesjournals.org/cgi/content/full/26/suppl_1/s62
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