Diet, Exercise, Culturally Sensitive Care Can Control Diabetes

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A healthy diet and exercise program are part of the prescription for people with type 2 diabetes, but two new research reviews suggest they can also help to prevent the disease.

A third review finds that patients from ethnic minorities do better with diabetes education that takes their language and culture into account.

Lower fat and higher fiber diets, combined with moderate weekly exercise, reduced the relative risk of developing type 2 diabetes by 37 percent among the 2,241 study participants who received the diet and exercise prescription, according to the data from a review of eight studies. Didac Mauricio, M.D., of the Hospital Universitari Arnau de Vilanova in Spain, led the review.

People who participated in these studies also lost weight, reduced their waist circumference and improved their blood pressure — all key factors related to the risk of developing diabetes.

However, they had substantial help from dieticians and exercise physiologists along the way, and because the changes in diet and exercise were monitored so carefully, “we do not presently know how these interventions perform outside a trial,” Mauricio said.

In another review by Lucie Nield of the University of Teesside and colleagues in England, diets rich in fruits and vegetables and lower in sugar reduced the incidence of type 2 diabetes among the participants in one six-year study by 33 percent.

The results from the second review make it clear that diet can stave off type 2 diabetes, but it remains unclear exactly what kind of diet to recommend to people who might be vulnerable to developing the disease, according to Nield.

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“Despite the current situation we are facing with the diabetes epidemic, there are not enough long-term data available to come to any confident conclusions,” Nield said.

Regular visits with dieticians — every three to six months during the studies — might also have played a significant role in getting people to stick with a healthy eating plan, Nield and her colleagues concluded.

The reviews appear in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

In a third Cochrane review, Yolanda Robles, Ph.D., an academic fellow at Cardiff University, and colleagues examined how the health of ethnic minority diabetes patients might improve if they were taught about the disease in their own language, “or by members of their community using health education materials that had been adapted to that community’s cultural needs,” Robles said.

This “culturally appropriate” education, as the researchers called it, had a short-term effect of lowering blood glucose (sugar) levels, but none of the interventions included in the review lasted more than a year. In the 11 studies reviewed, combination education strategies seemed to have the greatest positive impact on the health of the 1,603 participants.

“However, it should be borne in mind that we still do not know the necessary dose of health education needed or the level of reinforcement of messages to ensure continued benefits,” Robles cautioned. “Longer term studies, with more patient-centered outcomes, are needed.”

Earlier this month, a joint study by the American Heart Association, the American Diabetes Association, and the American Cancer Society found that aggressively treating pre-diabetes, along with quitting smoking and lowering cholesterol, could increase an American’s life expectancy by 1.3 years.

Weight control, quitting smoking, aspirin therapy and cholesterol-lowering medications are among the preventive measures that can add years to a person’s life, researchers from the three organizations concluded.

"People with diabetes are among those who would benefit the most from these prevention strategies," said Richard Kahn, Ph.D., chief scientific and medical officer of the American Diabetes Association.

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