Prevention of Type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise The 6-year Malmö feasibility study

SummaryFrom a previously reported 5-year screening programme of 6,956 47–49-year-old Malmö males, a series of 41 subjects with early-stage Type 2 (non-insulin-dependent) diabetes mellitus and 181 subjects with impaired glucose tolerance were selected for prospective study and to test the feasibility aspect of long-term intervention with an emphasis on life-style changes. A 5-year protocol, including an initial 6-months (randomised) pilot study, consisting of dietary treatment and/or increase of physical activity or training with annual check-ups, was completed by 90% of subjects. Body weight was reduced by 2.3–3.7% among participants, whereas values increased by 0.5–1.7% in non-intervened subjects with impaired glucose tolerance and in normal control subjects (p<0.0001); maximal oxygen uptake (ml · min−1 · kg−1) was increased by 10–14% vs decreased by 5–9%, respectively (p<0.0001). Glucose tolerance was normalized in > 50% of subjects with impaired glucose tolerance, the accumulated incidence of diabetes was 10.6%, and more than 50% of the diabetic patients were in remission after a mean follow-up of 6 years. Blood pressure, lipids, and hyperinsulinaemia were reduced and early insulin responsiveness to glucose loading preserved. Improvement in glucose tolerance was correlated to weight reduction (r=0.19, p<0.02) and increased fitness (r=0.22, p<0.02). Treatment was safe, and mortality was low (in fact 33% lower than in the remainder of the cohort). We conclude that long-term intervention in the form of diet and physical exercise is feasible even on a large scale, and that substantial metabolic improvement can be achieved which may contribute to prevent or postpone manifest diabetes.

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