medwireNews: Lifestyle intervention proves “highly successful” in adults with diabetes aged 65 to 85 years, improving both metabolic and functional health, report researchers.
“Although lifestyle intervention is recommended as first-line treatment of diabetes at all ages, older adults were often excluded or underrepresented in studies that led to this evidence,” Dennis Villareal (Baylor College of Medicine, Houston, Texas, USA) and colleagues explain in Diabetes Care.
They carried out a randomized controlled trial – Lifestyle Intervention for Seniors with Diabetes – involving 50 adults aged an average of 72 years with diabetes and comorbidities who participated in an intensive lifestyle intervention involving weight management and exercise training for 1 year.
By this point, the participants’ mean glycated hemoglobin (HbA1c) levels had dropped by 12.2 mmol/mol (0.8%), from a baseline average of 58.2 mmol/mol (7.5%). This was significantly greater than the 0.8 mmol/mol (0.1%) decrease from a baseline level of 55.7 mmol/mol (7.3%) seen in a comparison group of 50 similar individuals who instead adopted a healthy diet based on monthly educational sessions and did not participate in external weight loss or exercise programs.
The intensive lifestyle intervention comprised a balanced diet that provided a deficit of 500–750 kcal/day from daily energy requirement, but contained approximately 1 g/kg per day of high-quality protein to minimize a decrease in lean body mass. The aim was to lose about 10% of baseline bodyweight by 6 months and maintain the weight loss for a further 6 months.
Alongside weight management, the lifestyle intervention included exercise training, both aerobic and resistance exercises, three times a week for 90 minutes.
The superior glycemic control achieved with the intensive lifestyle intervention was associated with improved insulin sensitivity and disposition, as well as resistance and secretion.
This meant that for the participants taking insulin – almost half in each group – the daily dose needed at 1 year decreased by a mean of 19.8 units with the intensive lifestyle intervention, from a baseline of 93.8 units, which was a significant improvement on the 8.0 unit increase, from a baseline of 86.4 units, achieved with a healthy diet.
“Our findings suggest that in the specific population of older adults with diabetes, it may not be too late in life (mean age 72 years) to start lifestyle intervention, which can complement or reduce the need for medical therapy,” say Villareal and team.
“Indeed, lifestyle intervention could directly counter the increasing adiposity and physical inactivity that are primarily responsible for the age-related increase in insulin resistance.”
The study showed evidence of this, with body composition and physical function improving to a greater degree with the intensive lifestyle intervention.
For example, mean bodyweight and visceral fat decreased by a respective 8.4 kg and 261 cm3 with the intensive lifestyle intervention, which was significantly greater than the 0.3 kg and 30 cm3 decreases seen with a healthy diet.
And Physical Performance Test score and peak oxygen uptake both increased among adults in the lifestyle intervention group, by an average of 2.9 points and 2.2 mL/kg per min, respectively, but decreased among those in the healthy diet group, by a corresponding 0.1 points and 1.2 mL/kg per min.
However, Villareal and co-researchers point to the need for “regular self-monitoring of blood glucose and periodic review of blood glucose records to assess the need for medication adjustments during intensive lifestyle change,” having found an increase in hypoglycemic episodes, at 30 versus 20 events among those in the healthy diet group, particularly among those on insulin or insulin secretagogues.
The researchers assert that “nearly all episodes were mild (level 1) [and] promptly corrected with ingestion of easily absorbed carbohydrate.”
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