Speedy weight loss may put brakes on diabetes

JOHNS HOPKINS (US) - Dropping body weight by 10 percent within six months of a pre-diabetes diagnosis dramatically reduces a patient's risk of progressing to type 2 diabetes in the next three years, research shows.

The finding, investigators say, offers patients and physicians a guide to how short-term behavior change may affect long-term health.

"We have known for some time that the greater the weight loss, the lower your risk of diabetes," says study leader Nisa Maruthur, assistant professor of general internal medicine at the Johns Hopkins University School of Medicine.

"Now we understand that we can see much of the benefit of losing that weight in those first six months, when people are adjusting to a new way to eating and exercising," she says. "Substantial weight loss in the short term clearly should go a long way toward preventing diabetes." The study is published online in the Journal of General Internal Medicine.

Preventing pre-diabetes from becoming full-blown diabetes is critical, Maruthur says. Uncontrolled diabetes-marked by excess sugar in the blood-can lead to eye, kidney, and nerve damage as well as cardiovascular disease. The new research suggests that if people with pre-diabetes don't lose enough weight in those first months, physicians may want to consider more aggressive treatment, such as adding a medication to push blood sugar levels lower.

Patients with pre-diabetes have blood sugar levels higher than normal but not yet high enough to be classified as type 2 diabetes. Although not all people with pre-diabetes develop full-blown type 2 disease, the risk without intervention of getting it within 10 years is substantially increased and damage to health may already have begun.

The good news, Maruthur says, is that studies like hers show that the progression from pre-diabetes to type 2 diabetes is not inevitable and lifestyle changes can bring blood sugar levels back to normal.

Maruthur and her colleagues analyzed data from the Diabetes Prevention Program, the largest diabetes prevention study in the United States. Overweight, hyperglycemic people were recruited between 1996 and 1999 and followed for an average of 3.2 years. More than 3,000 participants at 27 academic medical centers were assigned at random either to receive an intense lifestyle intervention, doses of the diabetes drug metformin to reduce blood sugar, or a placebo.

Researchers found that those in the study who lost 10 percent or more of their body weight had an 85 percent reduction in risk of developing diabetes within three years. Even more moderate weight loss showed positive effects. Those who lost 5 to 7 percent of body weight reduced their risk of developing diabetes by 54 percent three years later.

Those who were given metformin, a drug that prevents the liver from producing too much glucose, did not lose significant amounts of weight on average. But those whose blood sugar levels were significantly lowered in six months of taking the medication saw their future risk of developing diabetes fall as well.

The lowest risk, Maruthur says, occurred in patients who lost weight and also lowered the amount of glucose in their blood, as measured by a blood test taken after fasting.

"I'm usually thrilled if a patient loses 3 to 5 percent of his or her body weight after six months, but based on this new knowledge, if patients aren't losing more weight and if their glucose remains elevated, it might be time to escalate treatment by prescribing metformin," she says.

Maruthur says few doctors use metformin in patients with pre-diabetes, but given what her new study shows, it might make sense for them to consider prescribing the drug to patients who are unable or unwilling to lose substantial weight in the short term.

The National Institutes of Health's National Center for Research Resources supported the research.

Source: Johns Hopkins University

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