Lifestyle vs Pharmaceutical Intervention

We're all well aware of the diabetes epidemic affecting the U.S. The problem continues to escalate with no signs of slowing yet. There are many factors that affect diabetes risk and prevalence, many of which we cannot control, but there are important lifestyle factors that we can influence - diet and exercise. Diet and exercise have been shown to help reduce the risk of the developing diabetes (by almost 60%). This was demonstrated in the Diabetes Prevention Program (DPP), a 3 year lifestyle intervention study. Moderate weight loss of 5-7% through diet and exercise helped significantly reduce diabetes risk.


Lifestyle has been shown to be beneficial, however, some believe it is not beneficial in the long-term and pharmaceuticals would be more successful at preventing diabetes. DeFronzo argues that the problem with lifestyle or behavioral interventions is that it is difficult to maintain weight loss and increased physical activity in the long-term (2011). In other words, the interventions work while the they are active but the benefits are not sustained since the lifestyle changes are not maintained in the long-term. The costs of an on-going intervention are also high. He points out that "weight regain is a characteristic feature of most weight loss programs, irrespective of the type of dietary intervention" (DeFronzo, 2011, para 12). For these reasons he supports the use of pharmacological agents as the intervention approach for reducing diabetes risk (or improving impaired glucose tolerance, IGT). DeFronzo argues that the main issue is not "whether weight loss works to prevent IGT progression to type 2 diabetes, but whether weight loss can be maintained without an intervention program that most individuals find difficult to follow and that is costly to implement and maintain" (2011, para 15). Interventions using pharmaceuticals have been shown to improve IGT and therefore help prevent diabetes. In the DPP study, Metformin reduced diabetes risk by 31%.


The question is do we treat pre-diabetes with medication or with lifestyle intervention? The pros to treating with medication is that the intervention isn't largely dependent on the person's behavior (other than the action of taking the medication) and therefore more controllable. Dose, frequency, compliance can be more easily measured and therefore more easily controlled. In comparison to diet and exercise where, outside of a strictly controlled environment, there is no way to really control a person's diet and know what they are eating and what activity level they are engaging in. What one person deems as healthy may be significantly different than what another person feels is healthy. What one individual views as vigorous exercise may be seen as light or moderate exercise by another. They are very subjective measures. So the pros is, more control by the health professional, less effort required from the individual and less dependent on unpredictable human behavior.Greater possibility for consistency and dependable results.


There are also cons to using treating more aggressively with medications. There is greater dependency on pharmaceuticals that often have many side effects. Pharmaceuticals are costly and the probability of harmful interactions increases with the increase in the number of medications taken. There are, essentially, no side effects to following a healthy diet and exercising regularly. It is costly to perform lifestyle interventions but the cost of a person choosing healthier foods and being more active is relatively small. Studies have shown that a healthy diet is not more expensive and money is not required to be more active (although there other factors to consider, like safe neighborhood,etc). Medications are important and they save lives but in my opinion, if we have a viable option where medication isn't needed or where we can use less, we should act on that. If we don't, we have given up on the person's ability to care for themselves.


Drugs or diet and exercise? Maybe both?


Reference

DeFronzo, R. A. (2011). Type 2 diabetes can be prevented with early pharmacological intervention. Retrieved from http://care.diabetesjournals.org/content/34/Supplement_2/S202.full

Lesson Plan Presentation Reflection

Diabetes Prevention - Controlling My Portions

I have really enjoyed this class and learned a lot from preparing the lesson plan. I have very little experience working with groups so this was out of my comfort zone. As a health coach I work primarily one-on-one and over the phone so it was a challenge, for me, working to figure out how to be more interactive with a group that's right in front of me.

I know I would have been much more comfortable just presenting a basic diabetes education lecture because I am familiar with the material but that isn't the most effective way to teach a group. The challenge was making the lesson more interactive and more student oriented. I certainly appreciate the value of having more interactive lessons. I really enjoyed everyones presentations and their interactive components.

I feel there are a several things that could have been done to improve my presentation. I seriously underestimated how nervous I would be presenting to my classmates. I knew I was nervous but the anxiety really crept up on me as I started the presentation. There was fidgeting and my voice started to crack. Thankfully I was able to keep going and focus on the presentation :-)

I feel that I need to work on the pacing of my words as I tend to speak fast. I also tend to jumble my thoughts and can over elaborate on one point while forgetting to discuss another. There were a few points that I left out because I just simply forgot or because I was afraid of going over on time. I also feel that I had some good examples but could have presented them in a clearer manner.

At the end I asked the class to give me examples of their meals. I felt that maybe I came across as critical of the foods chosen. I think a better approach would have been to ask about the meal and have them tell me a way to improve that meal choice for next time.

I think my strength is my familiarity with diabetes and the Hispanic population. I feel that I am comfortable working with this population and this particular disease and that helps as me as educator.  Overall it was fun presenting the material and pretending I had a group of Hispanic, Spanish-speaking women in front of me. The class was very helpful and played along. It really helped me ease into my presentation and helped me complete the lesson. Without the class's cooperation it would a very short and plain presentation.


To view the video please go to http://www.youtube.com/my_videos_edit?video_id=r2pOkinf31g

Western Diet and Diabetes

Our world is quickly becoming smaller and smaller. With advances in technology it is now easy to connect to someone across the globe, whether it's by jumping on a plane or using the internet. With rapid globalization also comes the spread of the Western lifestyle, including the Western diet. Studies have shown that the spread of the Western diet is linked to the global increase in diabetes prevalence. The Western diet is characterized as having a higher intake of red and processed meats, sweets and desserts, french fries, and refined sugars.

Two large studies demonstrated the link between the Western diet and diabetes in men and women. One study involved 69,554 women from the Nurses' Health Study (NHS). The women did not previous history of diabetes, heart disease or cancer. 

Two major dietary patterns were identified, "Western" and "prudent". The prudent diet is characterized by higher intakes of fruits, vegetables, legumes, fish, poultry and whole grains. The study found that the Western diet raised the risk of developing diabetes by 50%.    

A separate study examined 42,504 male health professionals, also without previous history of diabetes, heart disease and cancer. The two dietary patterns, Western and prudent, were identified. The findings showed that men who followed the Western dietary pattern had an almost 60% greater risk of developing diabetes when compared to men whose dietary pattern was more "prudent".   

It's scary to think that underdeveloped countries are seeing large increases in diabetes prevalence. The U.S. has many more resources yet we also are struggling to contain this epidemic. I can't imagine what this means for countries who don't have the resources we do. 

References

Fung, T. T., Schulze, M., Manson, J. E., Willett, W. C., & Hu, F. B. (2004). Dietary patterns, meat intake and the risk of type 2 diabetes in women. Archives of Internal Medicine, 164(20):2235-2240. doi:10.1001/archinte.164.20.2235

Van Dam, R. M., Rimm, E. B., Willett, W. C., Stampfer, M. J., & Hu, F. B. (2002). Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Annals of Internal Medicine, 136(3), pp 201-209