Dietary intervention can improve HbA1c after diabetes diagnosis
MedWire News: Specialist dietary advice helps patients newly diagnosed with Type 2 diabetes to significantly lower their glycated hemoglobin (HbA1c) levels, results of the Early ACTID (Early ACTIvity in Diabetes) trial show.
Robert Andrews (University of Bristol, UK) presented the findings of the Early ACTID trial at the American Diabetes Association annual meeting in San Diego, California.
The trial included 593 patients who were assigned to one of three treatment groups: usual care (n=99; initial dietary consultation, then 6-monthly follow-up); an intensive dietary intervention (n=248; 3-monthly dietary consultation, monthly nurse support); or dietary intervention plus physical activity (n=246; pedometer-based program) for a period of 1 year.
At 6 months, HbA1c levels had increased by 0.14% in the usual-care group, but decreased significantly by 0.28% in the diet group and by 0.33% in the diet-plus-exercise group. However, the difference between the reductions in the diet versus the diet-plus-exercise groups was not significant. The improvements were maintained at 12 months, even though the use of diabetes medication had been reduced.
In addition to reductions in HbA1c, the patients in the intervention groups achieved significantly improved body weight and insulin resistance by 12 months, although again these improvements did not differ significantly between the diet and diet-plus-exercise groups.
Andrews suggested that one reason that the participants in the diet-plus-exercise group might not have gained any apparent health benefits from the exercise "is because people often make a trade."
He explained: "That is, if they go to the gym, then they feel as if they can have a treat. That could be why we saw no difference in the weight loss for the diet-plus-exercise group."
"Getting people to exercise is quite difficult, and can be expensive. What this study tells us is that, if you only have a limited amount of money, in that first year of diagnosis, you should focus on getting the diet right," Andrews added.
As glycemic control tends to worsen over time, he suggested that exercise could be more useful at a later stage in the progression of Type 2 diabetes.
"In the early stages, people tend to make rapid improvements and then it stays the same for a while. Adding exercise later might provide another boost in control, whereas it wouldn't early on," he said.
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By Helen Albert