Doctors are happy to give advice to people at risk of developing type 2 diabetes. But patients often end up with diabetes anyway.
Basic lifestyle advice for people at high risk does not reduce the percentage who develop type 2 diabetes, according to a major NTNU survey.
“We gave people advice about motivation, diet and physical activity, with the same advice and to the same extent as a GP would,” says Anne Jølle, who is a GP herself.
Jølle investigated the prevention of type 2 diabetes (T2D) in her doctoral work at the Department of Public Health and Nursing and found remarkable results: that is, no results.
During the two years of follow-up, 10.3 per cent of the study participants developed type 2 diabetes. This is about the same as can be expected among people in the high-risk group who do not receive lifestyle advice.
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Tested over two years
Diabetes is often divided into two main groups. Type 1 diabetes is mainly the result of autoimmunity and partly genetics. People often develop the disease at a young age, regardless of their lifestyle.
But type 2 diabetes is a disease with multiple causes, where both lifestyle and genetics are important risk factors.
In HUNT 3, which is the major health survey in Nord-Trøndelag county, over 5000 people were found to be at high risk of developing diabetes in the next ten years. These individuals were invited to participate in a two-year follow-up study with the goal of preventing the development of T2D.
Nearly 2400 people attended group meetings offering basic lifestyle advice. They had follow-up sessions after 6, 12 and 24 months. About half of the participants took part in at least three of the four follow-up rounds.
Participants were divided into groups by sex, age, education and depressive symptoms. In all the subgroups, researchers found a similar increase in blood sugar and BMI during the follow-up period.
“The findings indicate that our strategy was not effective in reducing the risk of developing type 2 diabetes,” says Jølle.
Use of resources
Several good multidisciplinary follow-up plans have shown positive results in preventing type 2 diabetes in people at risk of developing the disease, but this type of follow-up is often very resource intensive.
In Norway, approximately 60 per cent of all municipalities offer programmes like this (called Frisklivssentraler), and fewer than 10 per cent of those at risk of developing T2D participate in them.
“With this information as a backdrop, we tried a less resource-intensive follow-up. However, it turned out not to help lower the percentage of type 2 diabetes in participants.
This means that we have to ask ourselves how we should use resources, says Jølle, while emphasizing that she is not opposed telling patients how to prevent diabetes.
But a GP might just as well give simple lifestyle advice to patients on the fly as calling them in for education sessions with more detailed information. It would probably have about the same effect. In other words, almost none.
“I think in the future we should concentrate on more targeted selection and prevention,” says Jølle. She sees this as a two-pronged task:
- The first is to identify patients who are at greatest risk of developing complications from type 2 diabetes.
- The second part involves choosing different preventive strategies. These have to take into account the resources and living conditions of patients who are at high risk of developing type 2 diabetes.
“The 19-year-old who’s gained 20 kilos over the past two years because he’s been sitting around playing computer games needs a very different plan of action than the single mom of 40 with arthritis,” says Jølle.
But in order to facilitate more personal strategies, we also need to know more about the disease. In the past, for example, some professionals have started sharing T2D among several subgroups.
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Stop it earlier
So if simple lifestyle advice doesn’t work, what can be done?
The danger of developing type 2 diabetes is also related to genetic factors, but it’s quite clear what the main problem is for someone who develops the disease.
“The risk of developing diabetes increases in line with how many kilos overweight you are,” Jølle says.
Losing weight is therefore key for individuals who are at risk for developing type 2 diabetes.
What is important is to prevent people from ending up in the high-risk group at all, by facilitating early support for good lifestyle choices. This applies at the individual as well as the population level.
“The most important thing is primary prevention. Build good habits early. Have kids go to school and teach them to make healthy food choices. Exercise,” she said.
This is also about how society is organized, not just about health education, says Jølle.
“We need to create the conditions so that people can make good choices for their health. We need good walking and cycling routes, safe parks and access to healthy foods. In addition, education, knowledge, and social and economic security affect many different aspects of our health,” she says.
Source: Basic lifestyle advice to individuals at high risk of type 2 diabetes: a 2-year population-based diabetes prevention study. The DE-PLAN intervention in the HUNT Study, Norway. Jølle A, Åsvold BO, Holmen J, Carlsen SM, Tuomilehto J, Bjørngaard JH, Midthjell K. https://www.ncbi.nlm.nih.gov/pubmed/29765613