Pre-diabetes: a catalyst for a positive lifestyle change

Two million Australians are currently living with pre-diabetes, which means that nearly one in six Australians over the age of 25 are at high risk of developing type 2 diabetes(1). With no obvious signs or symptoms to alert patients to abnormal blood glucose levels, many are unaware they are living with pre-diabetes.

Patients living with pre-diabetes have blood glucose levels higher than normal, but not high enough to be diagnosed with type 2 diabetes. 

A diagnosis of pre-diabetes can be that window of opportunity for health professionals to help patients prevent or delay the onset of type 2 diabetes by supporting them to make necessary lifestyle changes shown to reduce the risk of developing the condition. 

Evidence for the effectiveness of lifestyle change

Behaviour change around dietary choices, increasing exercise and weight loss can be challenging for patients, but evidence from large studies indicate that lifestyle interventions such these show positive results in the prevention of type-2 diabetes among people at high risk of developing the condition.

The Finnish Diabetes Prevention Study

The Finnish Diabetes Prevention Study was the first randomised controlled trial (RCT) that specifically investigated the effect of lifestyle interventions in preventing type-2 diabetes. After following participants for two years, the incidence of type-2 diabetes in the intervention group was less than half of that observed in the control group. Results from the study indicate that type-2 diabetes can be prevented in up to 58 per cent of people with pre-diabetes through lifestyle interventions such as choosing a healthy diet, regular physical activity and weight loss(2). 

The Diabetes Prevention Program

One of the largest RCTs compared a drug intervention, lifestyle intervention and a placebo group in the US and found that while, both lifestyle and drug interventions (Metformin) had positive effects on the prevention of type 2 diabetes and restoring normal glucose tolerance, the lifestyle intervention was more effective in preventing type 2 diabetes, particularly in older adults(3). The lifestyle intervention group also tended to have a lower mortality rate than the Metformin intervention group. Studies such as these have formed an important evidence base supporting the role of lifestyle interventions in preventing type 2 diabetes.

Choosing a balanced diet

According to the Australian Dietary Guidelines, enjoying a wide variety of nutritious food is associated with a reduced risk of chronic disease(4). Additionally, a 2017 systematic review and meta-analysis looking at food groups and risk of type 2 diabetes found a significant inverse relationship between consumption of dairy foods, fruits and grains, and risk of type 2 diabetes(5). These studies highlight the importance of a varied diet, however Australians are not meeting their daily recommended dietary serves across all five food groups according to the results of the 2011–2012 Australian Health Survey(6).

In regards to dairy foods, there are misconceptions that they are linked to weight gain and type 2 diabetes. However, evidence from a meta-analysis show that total dairy intake was associated with a 6 per cent lower risk of type 2 diabetes 200g/day consumption(7).

Additionally, studies have shown milk, cheese and yoghurt, including regular-fat varieties are not linked with development of type 2 diabetes(7) or weight gain(8). In fact, studies have shown yoghurt, cheese and reduced-fat milk are inversely associated with type 2 diabetes risk(7,9).

Weight loss and physical activity

According to Diabetes Australia, even moderate weight loss of 5–10 per cent of overall body weight can prevent type 2 diabetes in up to nearly six out of 10 people with pre-diabetes(10). Additionally, exercise and physical activity can help patients maintain a healthy weight or lose weight and help the insulin produced by the body work better and lower blood glucose levels(11).

Role of health professionals in supporting patients with pre-diabetes

Health professionals in primary care settings are best placed to support patients with pre-diabetes to make positive lifestyle changes that either prevent or delay the onset of type 2 diabetes. The team at Foods That Do Good have developed a pre-diabetes management guide, which has been reviewed by Baker Heart and Diabetes Institute. The guide allows health professionals to provide advice specific to their patient’s lifestyle. For tailored dietary advice, refer patients to an Accredited Practising Dietitian.

References

1. Diabetes Australia: https://www.diabetesaustralia.com.au/pre-diabetes
2. Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksoon J. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 2003; 26: 3230-3236.
3. Knowler W, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM. Reduction in the incidence of type 2 with lifestyle intervention or metformin. New England Journal of Medicine 2002; 346: 393-403.
4. National Health and Medical Research Council. Australian Dietary Guidelines, Canberra: Commonwealth of Australia; 2013.
5. Schwingshackl, L, Hoffmann, G., Lampousi, AM et al. European Journal of Epidemiology (2017). doi:10.1007/s10654-017-0246-y
6. Australian Health Survey: Consumption of Food Groups from the Australian Dietary Guidelines. Australian Bureau of Statistics. Released 11 May 2016.
7. Gao D, Ning N, Wang C, Wang Y, Li Q, Meng Z, et al. (2013) Dairy Products Consumption and Risk of Type 2 Diabetes: Systematic Review and Dose-Response Meta-Analysis. PLoS ONE 8(9): e73965. https://doi.org/10.1371/journal.pone.0073965
8. Drehmer, M. et al. Total And Full-Fat, But Not Low-Fat, Dairy Product Intakes Are Inversely Associated With Metabolic Syndrome In Adults. Journal of Nutrition 146.1 (2015): 81-89.
9. Gijsbers, L. et al. Consumption Of Dairy Foods And Diabetes Incidence: A Dose-Response Meta-Analysis Of Observational Studies. American Journal of Clinical Nutrition 103.4 (2016): 1111-1124. 
10. Diabetes Australia: https://www.diabetesaustralia.com.au/maintaining-a-healthy-weight
11. Diabetes Victoria: https://www.diabetesvic.org.au/Physical-activity?bdc=1