To Avoid Diabetes Complications, Think Lifestyle Changes Over Drugs

New study suggests diabetics might benefit more from diet and exercise than drugs.

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Ask most folks with a chronic, life-threatening health condition which fix they'd prefer—an overhaul of their eating and exercise habits or a pill—and chances are, they'll choose the pill. While that may be the easiest choice, a growing body of evidence suggests it's not always the wisest, at least when it comes to managing type 2 diabetes. Last week, the Food and Drug Administration decided to severely restrict access to the popular diabetes drug Avandia due to data suggesting "an elevated risk of cardiovascular events, such as heart attack and stroke," the agency said in a statement. What's more, none of the myriad diabetes medications on the market have been shown to lower the risk of dying from heart disease, the No. 1 killer of diabetics, according to results published a few months ago from an ongoing study called ACCORD. But new government-funded research published today in the Archives of Internal Medicine found that lifestyle trumps medication if people are serious enough about making changes; overweight individuals with diabetes who radically revamped their eating and exercise habits lowered heart disease risk factors far more than those who just took medications.

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While drugs prescribed to diabetics usually target a single heart risk factor like cholesterol or blood sugar, lifestyle changes can improve them simultaneously the study authors found. Another plus: Lifestyle changes don't have the nasty side effects commonly associated with blood-sugar lowering diabetes drugs like hypoglycemia, when blood sugar levels drop too low. While the 2,600 study participants who were randomly assigned to get intensive diet and exercise counseling were allowed to take medications, they generally needed far less or lower doses than the 2,600 participants assigned to get traditional diabetes treatments, including insulin and cholesterol-lowering statins.

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Although the study results are certainly promising, it takes a lot of effort to really manage diabetes without medication. The overweight study participants were put on portion-controlled diets or given free liquid meal replacements to help them stick with their weight loss plans, which called for 1,200 to 1,800 calories a day. They had consultations with personal trainers to help them meet their daily goal of 30 minutes of steady exercise like brisk walking or biking. And they were taught how to monitor themselves and curtail their temptations to binge on, say, brownies or Big Macs. "Whether such intensive efforts can be carried out on a broad scale in clinical practice...remains a major question," writes Prakash Deedwania, a physician and medical educator from the University of California, San Francisco, in an editorial accompanying the study.

And the study, which has so far collected four years of data, hasn't yet demonstrated that these lifestyle changes actually lead to fewer heart attacks or heart disease deaths. The researchers hope to find such evidence once they've collected the full 11 years of data. In the meantime, here's a 5-step action plan that could help reverse diabetes without medication.