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Which is Better, Taking a Pill for the Rest of Your Life or Changing the Way You Live for the Rest of Your Life?
Type 2 Diabetes and Exercise
Many physicians are of the opinion that type 2 diabetes - the kind seen mainly in overweight elderly patients and often called mature onset diabetes - can be brought under control without the use of medication, especially if it's not in an advanced stage. In an attempt to help clarify the issue, the Diabetes Prevention Program Research Group studied 3,234 individuals who had not yet been diagnosed with diabetes but did have elevated fasting and post-load plasma glucose concentrations. The idea was to separate these individuals randomly into 3 groups. Group 1 took the antidiabetic metformin at a dose of 850 mg twice daily.
 Group 2 was given a placebo instead. Group 3 was put on a lifestyle-modification program, which was designed to produce a minimum weight loss of 7% along with an exercise program of at least 150 minutes of physical activity per week. The list of investigators involved in the study is so extensive that it took up about 2 1/2 pages of single spaced typing and involved 27 different centers. The results were published in the February 7, 2002 issue of the New England Journal of Medicine under the title "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin." The objective was to determine which approach would be more likely to prevent or delay the development of diabetes. Unfortunately participants in the study were only followed for 2.8 years, at least at the time of submission for publication. This seems to be a rather insufficient way to evaluate the question. Nevertheless, significant differences were observed within this time frame.
Surprisingly, results were quite markedly different for the three groups. The placebo controls were found to develop diabetes in 11 individuals for every 100 person-years. Those who were taking metformin (Glucophage) did decidedly better at 7.8 cases. Remarkably, the figure dropped to only 4.8 cases for the lifestyle change group. This represented a reduction of incidence compared to placebo of 58 percent whereas the reduction was only 31 percent for the metformin. Even after only 2.8 years this is a marked difference favoring the lifestyle approach.
Additionally, it was found that there were some differences in adverse events between the metformin and lifestyle groups. The metformin group had a higher rate of gastrointestinal symptoms while the lifestyle group had a higher rate of musculoskeletal symptoms. Although no explanation was given we can readily surmise that more gastrointestinal symptoms would probably be forthcoming in those individuals who were ingesting daily pills. On the other hand, those individuals who were involved in a regular exercise routine would be more likely to experience aches and pains in their muscles and joints. Neither of these should detract to any degree from the final conclusions. Other factors that did not seem to play a role included race, ethnicity, and sex. There also did not appear to be any difference in results when the older patients were compared to the younger ones.
Studies in Finland and China had formerly reached similar conclusions and this one added to them. Nevertheless, one has to challenge the results of this study from a different perspective, which is partially responsible for my objection to its short time-span. It is one thing to expect someone who has reason to believe that he or she might one day develop diabetes because of some exam findings to opt to take some pills every day. It is quite another to expect the same individual to change his or her dietary and exercise lifestyle for a prolonged period of time. We need merely observe the multitude of failures by overweight persons with regard to adherence to long-term dietary and exercise programs.
I invite the reader to think about this for a moment. If you knew that you had about 11 chances per 100 person-years to develop diabetes within about the next 3 years, do you truly believe that you would markedly change your diet, and stick to an exercise program on a regular basis in order to reduce that risk to 4.8 chances? On the other hand, would you prefer to just take pills regularly, go about your usual lifestyle, and accept a risk of 7.8 chances? I'm glad that my own tests came out okay. I sure wouldn't want to have to make a decision like this. How about you?
A pill a day,
Sounds okay,
No problem dear,
No need to fear.
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Is it better still,
To drop the pill,
Add muscle aches,
And no more cakes?
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There is no way,
For me to say,
So I'll swallow pride,
And let doc decide?
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Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission.
Copyright © 2006 by Marvin Ackerman, M.D.
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