Type 2 diabetes WILL get worse without lifestyle change

We’re returning to the omnipresent topic of type 2 diabetes this week because there was a study published on 11th January 2018, which had some very important findings. The few media articles that covered the story managed to miss the most important findings. I think that the authors may have missed their biggest findings too. The Daily Mail ran with “Diet and exercise are 'better than drugs at controlling type 2 diabetes'” (Ref 1). The Daily Express headline was “Diabetes: Diet and exercise lifestyle programme could revolutionise type 2 treatment” (Ref 2). Both of these statements were true, but these were not the major findings.

The study

The study was another one from Glasgow (Ref 3). The Lancet type 2 diabetes study, which made global headlines in December 2017, was a randomized controlled trial led by Glasgow researchers (Ref 4). This January study was not a randomized controlled trial. It was a review of patient records, which could best be described as a retrospective epidemiological study.

The researchers used electronic health records to follow 23,208 patients with type 2 diabetes (T2D) and obesity in Glasgow for up to 3 years between 2005 and 2014. Patients were grouped by referral to and attendance at a lifestyle weight management intervention. “Successful completers” were defined as those who achieved a weight loss of ≥5kg following attendance of 7 to 9 sessions. Outcomes measured were weight, HbA1c (the measure of blood glucose over approximately 3 months) and diabetes medications taken.

The aims of the study were threefold. To examine: (i) whether a sustainable non-surgical weight management intervention helps patients achieve a long-term 5% to 10% weight loss; (ii) whether such weight loss improves glycaemic control; and (iii) whether such weight loss reduces anti-glycaemic medication use.