Evidence-Based Diabetes Management May 2015
Personal Coaching Halts Progression to Diabetes in Some Patients, Study Finds
A comprehensive coaching program, which combined traditional elements like nutrition and exercise counseling with efforts to control stress and correct disrupted sleep, succeeded in reversing elevated blood glucose levels in nearly half the patients with prediabetes who took part. Results of the study, released March 5, 2015, by the American College of Cardiology (ACC), were presented during the 64th Annual Scientific Sessions held March 14-16, 2015, in San Di-ego, California. The study’s lead author, Mariam Kashani, DNP, is chief scientific director at Walter Reed National Military Center, Bethesda, Maryland.
The study reports results of the Integrative Cardiac Health Project, which promotes healthy behavior to improve overall health and reduce cardiac risk. Researchers evaluated data for 508 consecutive participants, who were as-sessed for cardiovascular health and given personalized evaluations, fea-turing individual goals that met recognized preventive care guidelines. Of the participants, 107 had prediabetes, which meant their blood glucose levels were elevated, but not enough to be di-agnosed with type 2 diabetes mellitus (T2DM). Prediabetes is defined as glucose >100 mg/dL and <140 mg/dL.
Participants then took part in 14 coaching sessions over a 6-month pe-riod, either in person or by telephone, with specialists in nutrition, exercise, sleep, and stress management. Researchers sought to measure the effect of the intervention on blood glucose levels and other risk factors.
Of the participants who had pre-diabetes, 49% were able to return their blood glucose to <100 mg/dL regardless of whether they lost weight, which the researchers found notable. On average, participants who were able to regain nor-mal glucose metabolism lowered their fasting glucose level by 12%, dropping from 105.4 to 92.4 mg/dL. (See TABLE.)
“Many more patients reverted to normal blood glucose than expected, espe-cially if we consider that they were not necessarily losing weight,” Kashani said in a statement released by ACC. “This is important because prediabetes is a modifiable risk factor for cardiovascular disease.”
The measurable reductions in blood glucose levels were significant, she said, because each 5 mg/dL reduction brings a significant reduction in cardiovascu-lar risk. Patients with prediabetes also showed improvements in blood pressure, fasting insulin, perceived stress levels, and adherence to a Mediterranean diet, and reported feeling less tired.
A major limitation is that the study was observational and had no control group. However, Kashani said those who were able to revert to normal blood glucose levels also had signifi-cantly lower triglyceride levels at 6 months compared with others who remained prediabetic. A study to com-pare this lifestyle intervention to usual care is under way, according to the ACC statement.
According to Kashani, the findings show that interventions must go be-yond diet and exercise to include other factors. “By taking sleep and stress into account, we factor in important hormonal processes to better manage glucose,” she said. “When we are stressed, our bodies release extra glucose and when we are tired, we tend to make poor food choices. In this context, people often regain weight, and in doing so, they may revert back to worsening blood glucose levels.”
According to the American Diabetes Association, an estimated 86 million Americans have prediabetes, and 1 in 3 will develop T2DM within 5 years if elevated blood glucose levels are not ad-dressed. Risk increases with a family history of diabetes, weight gain, and a sedentary lifestyle.
Kashani M, Eliasson A, Engler R, et al. Prediabetes reversal using a novel comprehensive health model. Presented at the 64th Annual Scientific Sessions of the American College of Cardiology; March 14-16, 2015; San Diego, CA.