Cut the Waist

Cut the Waist

Diabetes & obesity: A joined up approach to management
A modest reduction in waist circumference can have significant long term health benefits

Diabetes prevention

The rising incidence of type 2 diabetes is closely associated with the epidemic of overweight and obesity. In the six years between 1997 and 2003, the number of new cases of type 2 diabetes in the United Kingdom has risen by 74%, demonstrating a more rapid acceleration than anticipated1. This magnitude of acceleration in the incidence of type 2 diabetes in the UK is also supported by another study which reports and annual rate of increase in Type 2 diabetes incidence of 11.8% occurring between 2003 and 20052.

"Pre-diabetes"

A significant driver of the Cut the Waist concept was to raise awareness of evidence from a number of major studies which clearly demonstrate that type 2 diabetes can be prevented in over half of the people known to be at high risk of developing this condition.

Many people are identified with impaired glucose control but do not reach the World Health Organisation criteria for a diagnosis of type 2 diabetes. "Pre-diabetes" or "non-diabetic hyperglycaemia" are terms often used to describe impaired glucose control which does not reach the diagnostic criteria for frank type 2 diabetes. People with pre-diabetes are at high risk of progression to type 2 diabetes over time.

Pre-diabetic conditions include either an impairment of glucose control identified in the fasting state [Impaired Fasting Glycaemia /IFG] or impairment of glucose control identified following a glucose challenge [Impaired Glucose Tolerance/IGT]. The conditions can occur in isolation or as a mixed picture of both IFG and IGT.

Type 2 diabetes

A single fasting venous glucose of ≥7mmol/l in the presence of symptoms suggesting type 2 diabetes.

In the absence of symptoms, diagnosis requires confirmation of a fasting venous glucose of ≥7mmol/l

A single random venous glucose of ≥11.1mmol/l in the presence of symptoms suggesting type 2 diabetes.

In the absence of symptoms, diagnosis requires confirmation of a random venous glucose of ≥11.1mmol/l or fasting venous glucose of ≥7mmol/l

Lifestyle approaches have proved to be effective in slowing the progression of pre-diabetes to type 2 diabetes. The major diabetes prevention studies listed below demonstrate that type 2 diabetes is a preventable or at least postponable condition in the majority of people who have pre-diabetes.

The Diabetes Prevention Programme (DPP) involved over three thousand participants with pre-diabetes. The DPP reported a 58% reduction in progression to type 2 diabetes via lifestyle changes associated with a loss of 6% of initial body weight and maintenance of 3.5% weight loss at 3 years3.

Similarly in the Finnish Diabetes Prevention Study, a dietary, exercise and behavioural change programme achieved a weight loss in the region of 4% that was maintained over 4 years. This lifestyle intervention reduced the incidence of progression to type 2 diabetes in subjects with impaired glucose tolerance IGT by 58%4. Furthermore, although the intervention ceased at four years, the subjects who received the lifestyle advice continued to be protected against developing type 2 diabetes when followed up 8 years after the start of the programme5. The Finnish Diabetes Prevention Study data clearly demonstrates that lifestyle intervention can result in long-lasting diabetes-prevention benefits.

The above studies provide evidence that small reductions in body weight in the region of 4% protect those at high risk from progressing to type 2 diabetes. To emphasize the impact of small changes in body weight, one study demonstrated a weight loss of just 1kg reduced the progression of patients with pre-diabetes (impaired glucose tolerance) to frank type 2 diabetes by 20% over a three year period of follow up6.

Acknowledgements

'Diabetes and obesity: a joined up approach to management' artwork reproduced with permission ©SB Communications Group 2009

References

1. Masso Gonzalez EL, Johansson S, Wallander M-A, Garcia Rodriguez LA. Trends in the Prevalence and Incidence of diabetes in the UK: 1996-2005. J Epidemiol Community Health 2009; 0: 1-5. doi:10.1136/jech.2008.080382 (accessed 7.09.2009)

2. Thomas MC, Hardoon SL, Papacosta AO, Morris RW, Wannamethee SG, Sloggett A, Whincup PH. Evidence of an accelerating increase in the prevalence of diagnosed Type 2 diabetes in British men, 1978-2005. Diabetic Medicine 2009; 26: 766-772

3. Diabetes Prevention Programme Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403

4. Diabetes Prevention Program Research G. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403

5. Lindstrom J, ILANNE-Parikka P, Peltonen M, Anoula S, Eriksson J, Hemio K. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow up of the Finnish Diabetes Prevention Study. Lancet 2006; 368: 1763-1679

6. Rasmussen SS, Glumer C, Sandbaek A, Lauritzen T, Borch-Johnsen K. Determinants of progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screened population: 3yr follow up in the ADDITION study, Denmark. Diabetologica 2008; 51: 249-257