The idea of controlling diabetes through diet and exercise has gained importance following renewed warnings about heart risk from some diabetes drugs and with the release of a University of Chicago study showing many diabetics believe treatment is as burdensome as complications of their disease.
Other research shows the most common form of diabetes, Type 2, can be controlled with diet and exercise alone and in some cases can even be reversed without diabetes medications.
Lifestyle modification, especially early in this lifelong disease, is key to lowering diabetic patients' high blood-glucose, or blood-sugar, levels and preventing long-term diabetic complications.
The only problem is, it's hard.
"This has to be a permanent lifestyle change, and that's the difficult part," said Christian Roberts, a physiologist at University of California at Los Angeles and the University of Southern California. He was the lead author of a study published last year that found a three-week diet and exercise program reversed Type 2 diabetes in 6 of 13 men.
In that study of a residential program, the men who succeeded no longer met the blood-sugar criteria for having diabetes or needed diabetes medication, even if they were still overweight. The researchers did not follow up with the patients to determine if they continued the high-fiber, low-fat Pritikin diet and 45 to 60 minutes daily of treadmill exercise at home. However, he said, other research using the same intervention on an outpatient basis showed similar results.
Another diabetes researcher said it is too much to expect people with diabetes, who already must frequently monitor their blood-sugar levels, to change their diet and start or increase exercise. Vicki Conn of the University of Missouri School of Nursing performed a large study that found twice the improvement in blood-sugar levels when diabetic patients focused only on exercise compared with those who tried to change exercise, diet and medication together. The study was published in the January issue of the journal Diabetologia.
"Our study suggests you can't get patients to do both [exercise and diet modifications] at the same time," said Conn, who is the nursing school's associate dean for research. "It may be easier to get them to focus on exercising."
Yet another study, published in the February issue of Diabetes Care, found that most people with diabetes do not exercise. According to the University of Colorado study, only 39 percent of adults with the disease reported they were physically active versus 58 percent of people without diabetes.
Obesity may make it harder to exercise. Most people with Type 2 diabetes are overweight, according to the American Diabetes Association. Diabetic complications such as nerve damage in the feet also may prevent exercise, said the ADA's president of medicine and science, Dr. Larry Deeb.
People with diabetes need at least 150 minutes of exercise a week to control their blood sugar, the ADA recommends. "That much exercise is hard to do," Deeb said.
What too often happens, according to Deeb, is patients leave their doctor's office with their diabetes uncontrolled and they promise to make lifestyle changes, which they end up not doing. To prevent progression of the disease, he believes, physicians should prescribe glucose-lowering medications right after diagnosis.
"We cannot allow people to have heart attacks and strokes, go blind and lose their feet because of diabetes," Deeb said. "There's terrible diabetes control in this country. We need to move forward aggressively with medical therapy."
New treatment guideline
A year ago the ADA changed its treatment recommendations for early Type 2 diabetes. This new guideline says to start drug therapy right after diagnosis, along with implementing lifestyle changes such as weight loss. The recommended drug is metformin because, according to Deeb, it has 30 years of data showing its safety.
That would avoid recent cardiac concerns about the thiazolidinedione class of diabetes drugs, including rosiglitazone, or Avandia.
But not every person with diabetes wants to start medicine right away. Dr. Leslie Mendoza Temple, director of integrative medicine at Evanston Northwestern Healthcare, said the patients she sees are looking for alternatives to medications, usually because of concerns about side effects.
"I always encourage them to consider taking medication, so they have all the allies in fighting this disease," she said. "I tell them letting diabetes get out of control is way more dangerous than the theoretical side effects of a medication they've never tried."