Early lifestyle changes in prediabetes improve cardiovascular risk profile

Findings from the Diabetes Prevention Program suggest that progression from impaired glucose tolerance to diabetes is associated with a deterioration in cardiovascular disease (CVD) risk factors. The findings state that individuals who developed diabetes trended toward higher blood pressure and triglycerides and lower HDL cholesterol than those who remained in a pre-diabetic state. But most importantly a report in the April issue of Diabetes Care shows that improvement in glucose tolerance, particularly with intensive lifestyle interventions, is associated with a more favorable CVD risk profile.

The Diabetes Prevention Program studied the development of diabetes in subjects with impaired glucose tolerance randomly assigned to metformin 850 mg twice daily (number of participants = 1073), placebo twice daily (n = 1082), or an intensive lifestyle modification (n = 1079). The goal of the lifestyle changes arm was to achieve and maintain a weight reduction of at least 7% and engage in moderate physical activity for at least 150 minutes/week.

Impaired glucose tolerance is defined as a 2-h plasma glucose of higher than 140mg% (7.8 mmol/L) and lower than 200mg% (11.1 mmol/L) during a 75-g oral glucose tolerance test, which was repeated annually during mean follow-up of 3.2 years. Average age was 51 years.

The largest changes were seen for transitions from impaired to normal glucose tolerance in the intensive lifestyle group, where systolic blood pressure and triglyceride level fell by about 25%, and HDL cholesterol (the „good cholesterol“) increased by roughly 8%. Changes were less in the metformin and placebo groups. But risk factor status deteriorated again rapidly if glucose tolerance worsened.

However there is no unique effect of conversion to diabetes, but rather a linear relationship between glycemic measures and risk factor levels. So small improvements also lower risk, even if you don’t reach perfekt goals at an early phase in the development of diabetes.