Wednesday, August 8, 2001

Exercise, diet
fight mid-life

Hawaii joined in a national study
that found healthy lifestyles can
reduce the onset of
Type 2 diabetes

10 million Americans are judged at high risk

By Helen Altonn

DIET AND EXERCISE can dramatically reduce chances of getting type 2 diabetes for an estimated 10 million high-risk Americans, including many Hawaii residents, a national study shows.

Intensive lifestyle changes for participants in a clinical trial reduced the risk of type 2 diabetes by 58 percent. Also effective in preventing the disease, but less so, was the drug metformin (Glucophage).

University "Clearly, lifestyle is very effective in reducing the rate of diabetes and medication is effective as well," said Dr. Richard Arakaki, University of Hawaii medical professor who conducted the Diabetes Prevention Program locally.

"The question is how do we take this information and get it out into the community and into public health considerations? Diabetes is considered nearly an epidemic across the country."

Type 2 diabetes -- about 95 percent of all diabetes cases -- most commonly affects adults over age 40 and is associated with obesity, inactivity, family history of diabetes and ethnicity.

Cases have tripled in the past 30 years, due largely to a ballooning obesity rate.

The Diabetes Prevention program was conducted by 26 mainland medical centers, the UH John A. Burns School of Medicine and The Queen's Medical Center.

The 3,234 participants included 74 Hawaii volunteers, ages 25 to 85. All had impaired glucose tolerance, a condition that often progresses to diabetes.

Hawaii has a higher rate of diabetes than the national average, primarily because of ethnic factors, Arakaki said.

An estimated 9 to 10 percent of Hawaii's population has diabetes compared with 6 to 8 percent nationally, he said. Hawaiians especially have a twofold to threefold increase compared to the national average, Arakaki said.

The findings, released today, were hailed by Health and Human Services Secretary Tommy G. Thompson:

"In view of the rapidly rising rates of obesity and diabetes in America, this good news couldn't come at a better time...

"By promoting healthy lifestyles, we can improve the quality of life for all Americans and reduce health care costs dramatically."

Participants initially were divided into four groups , one involving lifestyle changes with a low-fat diet and exercise, another with use of the drug metformin, one using the drug troglitazone combined with diet and exercise, and one group taking placebo pills instead of metformin.

The troglitazone arm of the study was halted in June 1998 because of potential liver toxicity. The other phases ended a year early because the main research question was answered.

Doing 30 minutes of physical activity daily with walking or other moderate intensity exercise, participants lost 5 to 7 percent of their body weight.

Those randomly treated with metformin reduced their risk of getting type 2 diabetes by 31 percent.

Participants all were overweight, with an average body mass index (BMI) of 34, and had impaired glucose tolerance.

About 29 percent of those taking placebo pills developed diabetes during a three-year follow-up period compared with 14 percent in the diet-exercise group and 22 percent of those taking metformin.

Arakaki said an estimated 20 million people have impaired glucose tolerance and will move on to diabetes. "We obviously need to do something."

The research program is funded until next June, and hopefully will continue for another five years, he said. The researchers will look at the long-term effect of measures to prevent diabetes and examine risks and rates of heart disease and stroke.

Arakaki said the $174 million research program represents "a major step toward the goal of containing and ultimately reversing the epidemic of type 2 diabetes in this country.

"Every year a person can live free of diabetes means an added year of life free of the suffering, disability and medical costs incurred by this disease."

American Diabetes Association

Ka Leo O Hawaii
University of Hawaii

E-mail to City Desk

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