Retrospective #210: “Diet and Exercise May Help Prevent Diabetes” – Duh!

I couldn’t believe this headline in my Medscape Alert email, so I opened the link and read the lede: “NEW YORK (Reuters Health) – Lifestyle changes made by people at high risk of diabetes appear to reduce their chance of developing the disease over the next two decades…” This revelation was also made by a group of doctors. However, that Reuters would assign a reporter to it, and then issue the story from New York, was utterly amazing to me.

The study was first reported online in the April 2014 Lancet Diabetes and Endocrinology. The original study began in 1986 and ended in 1992! In it, 568 people in China with “higher-than-normal blood sugar levels but not high enough to be diagnosed with diabetes,” were placed into three intervention groups (diet, exercise, or diet plus exercise), and a control group. The current study, begun in 2009, compared medical records of the 430 participants and 138 controls.

The goal of the original researchers (in 1986) was meritorious: “Diabetes is strongly associated with the increased risk of cardiovascular event and mortality,” the lead investigator of the 2009 study told Reuters. “They wanted to see if lifestyle changes, which included diet modifications and exercise, would help lower death rates.” As it turns out, they did, especially for women. But “because there are no data on people’s lifestyle habits during the (original) study period,” “it’s impossible to say…how the participants responded to the interventions,” the new study said. Okay.

But wait, we do have some data on the diet intervention. It “was meant to help people lose weight and normal-weight people reduce the amount of simple carbohydrate [sugars] they ate and the amount of alcohol they drank.” The Chinese understood in the 1980s the role of carbohydrates in reducing the risk of cardiovascular disease. So, it is all the more bewildering to me that the lead investigator would say today, “We have to do something active to delay the development of diabetes in high-risk populations.” How could that be any plainer? What was he unable to see?

The results of the 2009 study were impressive. “By the end of 2009, they determined that 28% of the intervention group had died, compared to 38% of controls.” “Twelve percent of the intervention group had died of heart-related conditions, compared to 20% of controls.” And, “Almost all of the benefit was found in women – there was very little difference in death rates among men based on whether they went through one of the lifestyle programs.”

The Reuters piece also reported, “The researchers also compared diabetes diagnoses and found that 73% of the intervention group had developed diabetes through 2009,” a very high number indeed but still lower than the control group’s 90%. Reuters related that the Lancet piece reported, “Those finding were similar for men and women.”

The big takeaway from this story, though, was: “The group-based lifestyle interventions over a six-year period have long-term effects on prevention of diabetes beyond the period of active intervention.” The researchers concluded, “It is worth taking active action to prevent diabetes to reduce the risk of cardiovascular disease and mortality.” Now, if only they could figure out what the action should be… Maybe there’s a clue in the paragraph above that begins, “…we do have some data on the diet intervention:” “…THE AMOUNT OF SIMPLE CARBOHYDRATES (SUGARS) THEY ATE…”

The first 3 comments online were “interesting.” The first, by a pharmacist, was “…and they discovered the warm water.” I’m not sure of the allusion, but I’m pretty sure the comment is intended as sarcasm. The second comment is from an advanced practice ob/gyn nurse. It was, “Oh wow, this is groundbreaking!” I’m almost certain (and hopeful) that this is pure mockery. The third comment was from a physician. He said, “Useful study.” If my impressions are correct, and I admit to a confirmation bias here, the pharmacist and the nurse were better informed about diabetes nutrition than the doctor. That, of course, is sad and all the more reason to lament the lack of nutrition education in medical school (see Retrospective #208, “Teach Doctors Nutrition”), and the misinformation being disseminated by our government, the medical/big pharma cabal and the big food manufacturing industries in the world today.

Perhaps the value of reporting over and over again the self-evident truth about low-carb eating to lose weight and improve health outcomes has some value after all. Eventually, more and more doctors will open their minds to the science they should have learned when they were in medical school. I can hope, anyway…