Medical Nutrition Therapy, Physical Activity, and Health Maintenance Considerations for Patients with Diabetes
Nigro, Stefanie C., Ellis, Kara, Drug Topics
With the prevalence of diabetes on the rise, timely and ongoing interventions are needed to promote healthy living and prevent chronic disease. Lifestyle modifications such as medical nutrition therapy (MNT) and physical activity have been shown to improve metabolic control, reduce the risk of developing type 2 diabetes, and decrease mortality. Therefore, all patients with pre-diabetes or existing diabetes should receive formal and ongoing MNT counseling in conjunction with regular physical activity. Meal planning utilizing all macronutrients is recommended to meet normal nutrient needs and glycemic control.
Diabetes mellitus is a complex metabolic disorder caused by various pathophysiologic abnormalities, most notably beta-cell dysfunction, increased peripheral resistance to insulin, and impaired incretin secretion/sensitivity.1 It is estimated that approximately 26 million (8.3%) Americans have diabetes and an additional 79 million with prediabetes are at risk for developing the disease.2 Persistent hyperglycemia can lead to both microvascular (nephropathy, neuropathy, and retinopathy) and macrovascular (coronary and peripheral vascular) complications. According to recent data, diabetes is the seventh leading cause of death in the United States and costs the healthcare system approximately $174 billion in direct and indirect medical costs.2"4 Without targeted interventions for both prevention and treatment, the prevalence and cost of diabetes will continue to rise.
Four modifiable risk factors are believed to contribute to the development of chronic disease: lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption.5 According to 2010 data from the Centers for Disease Control and Prevention (CDC), approximately 36% of patients with diabetes are sedentary and 84% are overweight or obese.2 Because both physical inactivity and poor nutrition are risk factors for the development of type 2 diabetes, prevention and treatment approaches must include lifestyle interventions. The American Diabetes Association (ADA) recommends that all patients with pre-diabetes and established type 2 diabetes implement lifestyle changes at the time of diagnosis.6
Lifestyle interventions for diabetes prevention
At the core of diabetes management is lifestyle modification, which includes medical nutrition therapy (MNT) and physical activity. MNT and physical activity are both individually effective prevention and treatment strategies, but their combination has been shown to delay the development of type 2 diabetes, according to findings from the Diabetes Prevention Program (DPP) study.7
The DPP was a randomized, controlled trial to assess whether lifestyle interventions or treatment with metformin could prevent or delay the onset of diabetes in highrisk individuals (those with impaired glucose tolerance). A total of 3,234 nondiabetic patients between 25 and 85 years of age were randomly assigned to 1 of 3 groups: intense lifestyle interventions, standard lifestyle recommendations plus metformin 850 mg twice daily, or standard lifestyle recommendations plus placebo. Standard lifestyle recommendations highlighted general healthy eating tips and were provided by written instruction and through an annual 20- to 30-minute in-person session. Those in the intense lifestyle intervention group were prescribed a healthy low-calorie, lowfat diet in conjunction with 150 minutes per week of moderate-intensity physical activity. The goal was to lose and maintain a 7% reduction in body weight. Average follow-up was 2.8 years.
At the conclusion of the study, those in the intensive lifestyle intervention group had a 58% reduction in the risk for developing type 2 diabetes compared to a 31% reduction observed in the metformin group.7 DPP study findings confirm the impact of early lifestyle changes in reducing the incidence of diabetes. For this reason, the ADA recommends that all patients with pre-diabetes or existing diabetes should receive formal and ongoing MNT counseling in conjunction with regular physical activity. …