An Epidemic of Diabetes
Reports from the National Health and Nutrition Examination Survey (NHANES) estimate that there has been an increase in the prevalence of diabetes over the past 2 decades from 5.5 to 9.3% ! This is troubling for a number of reasons, including increased morbidity and mortality, increasing polypharmacy, increasing health care costs, and greater disability over time.
In my experience, diet and lifestyle changes can have a major impact on glycemic control. Unsurprisingly, this is supported in the literature as well. Often times a motivating factor for my patients with diabetes will be working on the lifestyle changes, and over time cutting down on the amount of medications or the doses of medications that they require. Particularly if they can get off of insulin and still achieve that HbA1c of less than 7%!
In terms of prevention of diabetes in patients with impaired fasting glucose or pre-diabetes, studies show a marked decrease in the development of diabetes with increased exercise and maintenance of weightloss. For example, in the Diabetes Prevention Program Trial, pre-diabetic patients who were randomized to usual care versus the intervention arm (7% weightloss and exercised 150min/week) had a 58% reduction in incidence of development of diabetes. The number needed to treat with lifestyle intervention was 6.9. Patients in another arm of the trial were prescribed metform 850mg BID, there was a 31% reduction in incidence of diabetes compared to placebo, and the number needed to treat was 13.9. Both strategies help, but lifestyle intervention was more effective in preventing progression to diabetes.
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Many of us are pressed for time however, and the task of helping our patients to achieve a 7% weightloss is very daunting. However, some proportion of patients are motivated to make healthy lifestyle changes and other patients will become motivated as we talk with them in a collaborative rather than directive manner. Meet your patient where he or she is; sustained change often does not happen overnight. Be likeable while still giving sound medical advice – your patient is much more likely to listen to you this way… Then when your patient is ready and willing to start making healthy diet and exercise choices, it’s important to be well equipped to help them out.
Remember, it’s not just the number on the scale that’s the all important factor either. There is great importance to the amount of sugar and the biochemistry of the food we consume.
In addition to the handouts found on this website, another very useful tool for counseling patients about healthy lifestyle changes is the UCSF Diabetes Teaching Center Website, which contains both provider education links as well as patient informational handouts.