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People With Pre-Diabetes Who Drop Substantial Weight May Ward Off Type 2 Diabetes - 07/16/2013

Release Date: 07/16/2013

People with pre-diabetes who lose roughly 10 percent of their body weight within six months of diagnosis dramatically reduce their risk of developing type 2 diabetes over the next three years, according to results of research led by Johns Hopkins scientists.

The findings, investigators say, offer patients and physicians a guide to how short-term behavior change may affect long-term health.

“We have known for some time that the greater the weight loss, the lower your risk of diabetes,” says study leader Nisa Maruthur, M.D., M.H.S., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine. “Now we understand that we can see much of the benefit of losing that weight in those first six months when people are adjusting to a new way to eating and exercising. Substantial weight loss in the short term clearly should go a long way toward preventing diabetes.”

Preventing pre-diabetes from becoming full-blown diabetes is critical, Maruthur says. Uncontrolled diabetes — marked by excess sugar in the blood — can lead to eye, kidney and nerve damage, as well as cardiovascular disease. The new research suggests that if people with pre-diabetes don’t lose enough weight in those first months, physicians may want to consider more aggressive treatment, such as adding a medication to push blood sugar levels lower.

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“I’m usually thrilled if a patient loses 3 to 5 percent of his or her body weight after six months, but based on this new knowledge, if patients aren’t losing more weight and if their glucose remains elevated, it might be time to escalate treatment by prescribing metformin,” she says.

Maruthur says few doctors use metformin in patients with pre-diabetes, but given what her new study shows, it might make sense for them to consider prescribing the drug to patients who are unable or unwilling to lose substantial weight in the short term.

When blood tests indicate pre-diabetes, doctors like Maruthur often discuss with their patients the changes they can make to hopefully stave off type 2 diabetes. “Right now, the doctor and patient discuss this and may not discuss it again until the next appointment, which may be six months away or even longer,” she says. “This routine isn’t getting us anywhere.”

She says doctors don’t effectively provide behavior modification programs, in part because insurance rarely covers them. The new research suggests just how valuable — and potentially cost-effective — such interventions could be, she says.
 
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