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The Honolulu Advertiser

Posted on: Thursday, August 9, 2001

Study shows risk of diabetes reduced

By Katherine Nichols
Advertiser Staff Writer

A breakthrough clinical trial conducted at 27 medical centers nationwide, including the John A. Burns School of Medicine at the University of Hawai'i and the Queen's Medical Center, has shown that Americans with the potential to develop type 2 diabetes can effectively reduce their risk of getting the disease by 58 percent through diet and exercise.

The same study found that treatment with the oral diabetes drug metformin (GlucophageŽ) reduced risk by 31 percent.

Called the Diabetes Prevention Program, the nationwide study followed 3,234 overweight people with impaired glucose tolerance, a condition of elevated blood sugar that often precedes diabetes. According to Dr. Richard Arakaki of the John A. Burns School of Medicine, 74 volunteers from Hawai'i participated in the national study.

"We're clearly at high risk," said Arakaki. "Our rates of diabetes are much higher in Hawai'i than the national average." He estimated that 90,000 to 100,000 people in Hawai'i suffer from diabetes, with many more remaining undiagnosed. Compared with Caucasians, Asian Americans are one-and-a-half times as likely and Hawaiians two to three times as likely to develop diabetes.

Even simple intervention could make a "tremendous impact," said Arakaki, who has been part of the department of Medicine since 1990. However, he also said it will take time to "develop a plan to implement results into the community at large."

Forty-five percent of the participants in the study represented minority groups that suffer disproportionately from type 2 diabetes, including African Americans, Hispanic Americans, Asian Americans and Pacific Islanders, and American Indians. Others at high risk for type 2 diabetes who joined the study were individuals age 60 and older, women with a history of gestational diabetes, and people with a family history of the disease.

Participants ranged in age from 25 to 85, with an average of 51.

Diabetes Prevention Program volunteers were randomly assigned to one of three groups: those who modified their lifestyle and reduced their weight 7 percent through a low-fat diet and 150 minutes of moderate intensity exercise (mostly walking) each week; those who were treated with the drug metformin (850 mg twice a day), approved in 1995 to treat type 2 diabetes; those in the control group, who took placebo pills instead of metformin. During the average follow-up period of three years, 29 percent of the control group developed diabetes, as opposed to 14 percent of those who altered their diets and incorporated exercise into their routine. In the metformin section, 22 percent developed diabetes.

"Clearly the lifestyle intervention was more effective than the medication," said Arakaki. But he noted that an exercise regimen might be too difficult for some people to maintain, making medication a "reasonable option" in some cases.

More than 16 million people in the United States suffer from diabetes. It is associated with obesity, inactivity, family history of diabetes and racial or ethnic background, and is a major cause of kidney failure, limb amputations, new onset blindness in adults, heart disease and stroke.

The study cost $174.3 million. It is the first major clinical trial to show that diet and exercise can delay diabetes for those at high risk for developing the disease.