Drop the Weight and the Diabetes Risk

Diabetes may be avoided in prediabetes patients with weight loss within six months of diagnosis

(RxWiki News) People with prediabetes have high blood sugar levels, but not high enough to be called diabetes. Although they're heading in the direction of developing diabetes, they can turn things around by dropping some pounds.

Prediabetes does not mean diabetes is unavoidable. Research has shown moderate weight loss and exercise can prevent or delay type 2 diabetes among adults at high risk of diabetes, according to the Centers for Disease Control and Prevention (CDC).

In a recent study, researchers found people with prediabetes who lost roughly 10 percent of their body weight within six months of diagnosis drastically reduced their risk of developing type 2 diabetes over the following three years.

"Lose weight to reduce your chances of getting diabetes."

Nisa Maruthur, MD, an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine in Baltimore, led this study which found that time may be of the essence when it comes to reversing the course of prediabetes.

"We have known for some time that the greater the weight loss, the lower your risk of diabetes," said Dr. Maruthur in a press release. "Now we understand that we can see much of the benefit of losing that weight in those first six months when people are adjusting to a new way of eating and exercising. Substantial weight loss in the short term clearly should go a long way toward preventing diabetes."

The scientists based their conclusions on information gathered from the Diabetes Prevention Program (DPP), the largest diabetes prevention study in the United States. The more than 3,000 participants were overweight and hyperglycemic (having high blood sugar levels). They randomly received either an intense lifestyle intervention (involving eating habits and exercise), a placebo (fake medication) or doses of the diabetes medication metformin, which helps reduce blood sugar levels. It is sold under the brand names Fortamet, Glucophage, Glucophage XR, Glumetza and Riomet.

The study authors reviewed the information for connections between short-term weight loss, reduction of blood sugar levels and impact on the longer-term risk of developing diabetes.

They discovered that patients in the lifestyle intervention group who lost 10 percent or more of their body weight had an 85 percent reduction in risk of developing diabetes within three years.

Those who lost a moderate amount of weight also had positive results. Individuals who lost 5 to 7 percent of their body weight lowered their risk of developing diabetes three years later by 54 percent.

The lifestyle group participants were advised about better eating habits, directed to exercise 150 minutes a week, and given one-on-one counseling for the first six months and group counseling thereafter.

While those receiving metformin did not lose significant amounts of weight, those whose blood sugar levels were significantly lowered during six months of taking the medication saw their risk of developing diabetes fall.

Dr. Maruther pointed out that the lowest risk for getting diabetes occurred in patients who lost weight and also lowered the amount of sugar in their blood.

She stressed that if patients are losing weight with diet and exercise after six months, but blood sugar levels are remaining high, then medication may be needed.

"I'm usually thrilled if a patient loses 3 to 5 percent of his or her body weight after six months, but based on this new knowledge, if patients aren’t losing more weight and if their glucose remains elevated, it might be time to escalate treatment by prescribing metformin," Dr. Maruther said in a statement.

She added that not many doctors use metformin to treat prediabetes. Based on these results, however, she believes doctors should consider prescribing the medication to patients who are unable or unwilling to lose substantial weight in the short term.

When a doctor first discovers a patient has prediabetes, he or she may recommend ways to stave off the disease, but that doctor may not see the patient again for six months to gauge if lifestyle changes are working, according to Dr. Maruther.

"This routine is not getting us anywhere," she said.

Dr. Maruther suggested that more frequent patient assessments by doctors could help ensure that those with prediabetes are getting treatments that are producing positive results.

This study was published online in July in the Journal of General Internal Medicine.

Dr. Maruthur’s work is supported by a grant from the National Institutes of Health’s National Center for Research Resources.

Review Date: 
July 23, 2013