Encouraging patients newly diagnosed with Type 2 diabetes to diet or to diet and increase their physical activity reduces markers of inflammation and their cardiovascular risk compared with usual care, real-world study findings show.
“Our results show that motivational unsupervised diet and diet plus physical activity interventions, integrated into healthcare settings and with relatively modest resource implications, generate beneficial changes in various inflammatory markers in early [Type 2 diabetes]”, lead author Dylan Thompson (University of Bath, UK) and colleagues say.
The study involved 593 patients, aged between 30 and 80 years, who had been diagnosed with Type 2 diabetes within the previous 5 to 8 months. None of the participants had indicators of severe disease or cardiovascular risk at enrollment.
Patients randomly assigned to receive the intensive diet intervention (n=248) were encouraged to lose 5–10% of their initial body weight by attending 6-weekly appointments with study nurses and having contact with a dietitian every 3 months. The intensive diet and physical activity group (n=246) were additionally asked to undertake at least 30 minutes of brisk walking on 5 or more days per week. The remaining 99 patients received standard exercise and dietary advice.
Over the first 6 months of the study, treatment was only changed if patients became symptomatic, or if their fasting blood glucose concentration rose to more than 12 mmol/L or their blood pressure was above 160/90 mmHg at any visit. During the subsequent 6 months treatment was revised by doctors as appropriate to meet standards of care.
Writing in JAMA, the authors report that, at 6 months, patients in the diet intervention group had serum C-reactive protein (CRP) levels that were, on average, a significant 21% lower than those of patients receiving usual care, and a significant 22% lower for those receiving the diet plus physical activity intervention.
Similarly, adiponectin levels were 6.6% lower with diet and activity and 8.1% lower with diet alone, compared with usual care, while the differences for soluble intercellular adhesion molecule (sICAM)-1 levels were 5.7% and 5.2%, respectively.
Over the following 6 months, when doctors were able to make adjustments to medication, the effect of diet and physical activity on CRP levels was substantially attenuated, but the researchers note that diet and diet plus activity significantly reduced the chances of patients having high-risk CRP levels above 3 mg/L, by 28% and 33%, respectively.
Usual care was not successful to this end, the researchers note, adding that diet and diet plus physical activity were also “more effective than usual care at improving sICAM-1, a marker of vascular risk, even when medication was used to control blood pressure, HbA1c [glycated haemoglobin], and lipids to agreed international targets.” An improvement that was sustained at 12 months.
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