Recommendations from others
The American Diabetes Association recommends structured programs that emphasize lifestyle changes, including education, reduced fat and energy intake, regular physical activity, and regular participant contact. These changes can produce long-term weight loss of 5% to 7% of starting weight and reduce the risk for developing diabetes.4 They also stress the importance of promoting exercise as a vital component of the prevention as well as management of type 2 diabetes. The benefit of exercise in improving the metabolic abnormalities of type 2 diabetes is probably greatest when it is used early in its progression from insulin resistance to impaired glucose tolerance to overt hyperglycemia.5 The Exercise was more effective in reducing diabetes in lean patients, but overweight patients also benefited World Health Organization states that increased physical activity and maintaining a healthy weight play critical roles in the prevention and treatment of diabetes.6
CLINICAL COMMENTARY
Encourage patients to exercise and eat well, and see a dietician if they are willing
Julia Fashner, MD
St. Joseph Family Medicine Residency, South Bend, Ind
Diet and exercise are important components in the management of patients at risk for diabetes; the challenge revolves around the time and money commitment necessary for these interventions. A physician in a typical office setting has limited time to implement the interventions used in these trials. Referral to other health professionals (dietician, exercise physiatrist, etc) for counseling or individual guidance may be prohibitively costly, as these services are often not covered by insurance, and patients may not be willing to pay.
Bottom line—at every office visit, encourage patients to increase their exercise and watch what they eat as part of prevention. If they are willing to see a dietician, by all means send them.