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