Lifestyle Modifications Slow Progression To Diabetes As Effectively As Medications Interview with:
Dr. Karla Galaviz PhD
Hubert Department of Global Health
Rollins School of Public Health
Emory University
Sonya Haw, MD| Assistant Professor
Division of Endocrinology, Metabolism & Lipids
Emory University, School of Medicine
Grady Memorial Hospital
Atlanta, GA What is the background for this study? What are the main findings?

  • Diabetes affects 1 in 11 adults worldwide and though there is evidence that lifestyle modification (eating healthier diets and exercising about 150 mins a week) and certain medications can prevent or delay diabetes onset, it is not clear which of these strategies offers long-term benefits.
  • To answer this question, we compiled all available randomized controlled trials of lifestyle programs and medications to prevent diabetes and analyzed the data to see if the diabetes prevention effects persisted in the long-term. We specifically compared studies where the lifestyle or drug interventions were discontinued to see if the effect was long lasting or diminished when the intervention was stopped. What should clinicians and patients take away from your report?

  • Among individuals at risk for diabetes, healthy lifestyle changes and certain medications reduced diabetes risk to a similar extent – by about 40% compared to doing nothing.
  • The diabetes prevention effects of medications ended when the medications were stopped, whereas lifestyle modification programs showed continued effect, with slower progression of diabetes an average of 7 years later.
  • With time, the benefits of the lifestyle programs also declined (to about half of original benefits observed at 3-4 years).
  • Even moderate weight loss of just 1 kg was associated with reduced diabetes risk What recommendations do you have for future research as a result of this study?

  • Since the effect of lifestyle intervention also decrease over time, future research should be focused on identifying cost-effective, successful maintenance strategies to prolong preventive effects.
  • Additionally, it is not clear that these benefits are shared equally by all people at high risk of diabetes and there needs to be more studies exploring if and how these interventions work in people with different high-risk profiles (for example, those with impaired fasting glucose alone, impaired glucose tolerance alone, and those with both impaired fasting glucose and glucose tolerance). This may help us individualize prevention approaches.
  • More data regarding costs, cost-effectiveness, and approaches to implement lifestyle programs in different settings are also needed. Is there anything else you would like to add?

  • Lifestyle modification interventions are better than medications in the long-term, though strategies to prolong preventive effects are warranted.
  • There remain continued challenges in identifying people at high risk for diabetes, in financing prevention programs, and in motivating people at high risk to attend lifestyle programs. Efforts and research in the areas of behavioral economics may be helpful. Thank you for your contribution to the community.


Haw JS, Galaviz KI, Straus AN, Kowalski AJ, Magee MJ, Weber MB, Wei J, Narayan KMV, Ali MK. Long-term Sustainability of Diabetes Prevention ApproachesA Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Intern Med. Published online November 06, 2017. doi:10.1001/jamainternmed.2017.6040

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. 

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