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 HE MOST common form of diabetes may be delayed or prevented in high-risk patients with an inexpensive, drug-free program of diet and exercise says a study published on Thursday by Finnish researchers. But some diabetes experts say the same program may not work as well in Americans.
The study involved 552 middle-aged, overweight patients in Finland who have elevated blood sugar, a pre-diabetic condition called impaired glucose tolerance.
Epidemiologist Jaakko Tuomilehto of the National Public Health Institute in Helsinki and colleagues report in Thursday's New England Journal of Medicine that those who were put on a programme of moderate exercise, dietary counseling and weight loss reduced their chances of progressing to diabetes by 58 per cent.
The study was initially reported last June at a meeting of the American Diabetes Association.
Christopher Saudek of Johns Hopkins University, president elect of the diabetes association, says the study shows "that in a relatively homogenous group of people in Finland, a weight-loss program will be conclusive," but "the question is whether this result applies in any way, shape or form to Americans at risk for diabetes. We have a far more diverse population, a more diverse set of cultural and dietary norms."
A large National Institutes of Health-funded study under way in the US will answer that question, Saudek says.
The Diabetes Prevention Program involves more than 3,000 Americans with impaired glucose tolerance. Participants are given a diabetes drug or a program of diet and exercise.
A control group is given a placebo and information on diet and exercise. Results are expected in the fall of 2002.
Diabetes, which affects more than 16 million Americans, is caused by the body's inability to produce or use insulin properly, resulting in high levels of blood sugar. About 90 per cent of them have type 2 diabetes, which is caused by a combination of insulin resistance and some degree of insulin deficiency.
At highest risk are blacks, Hispanics and Native Americans. In type 1, the body produces no insulin at all.
In an accompanying editorial in the New England Journal, Antonio Tataranni and Clifton Bogardus of NIH in Phoenix say the Finnish study should encourage physicians to "persevere in the difficult task of promoting a healthy lifestyle, since by doing so they will give patients a better chance at a life less burdened by many diseases, including type 2 diabetes.
Anita Manning
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