Lifestyle changes more effective than drugs for diabetes prevention long-term, study finds

In the long-term, lifestyle modification is better at preventing diabetes among high-risk individuals than medications, according to researchers from the Emory University School of Medicine and Rollins School of Public Health.

Lead investigators Karla Galaviz, PhD, MSc in the Hubert Department of Global Health at Rollins School of Public Health and J. Sonya Haw, MD, in the Division of Endocrinology at the Emory University School of Medicine, published a paper titled, Long term Sustainability of Diabetes Prevention Approaches: A Meta-analysis of Randomized Clinical Trials that sought to determine the long-term efficacy of diabetes prevention strategies. 

Available online in JAMA Internal Medicine, the paper identifies best diabetes prevention strategies based on a systematic search and meta-analysis of studies testing lifestyle modification strategies and medications for reducing diabetes risk. The research team extracted and calculated the number of patients who developed diabetes at the end of the active intervention period and the end of the washout or follow-up periods across studies and calculated pooled relative risks for the different interventions tested. 

Among lifestyle modification interventions, combined diet and physical activity modification achieved the largest risk reductions; for medications, weight loss and insulin-sensitizing agents achieved the largest risk reductions.

"Implementing proven diabetes prevention strategies is imperative to slow worldwide growth of diabetes-related morbidity and mortality," says Galaviz. "Our findings show that, in adults at risk for diabetes, lifestyle modification and medications, specifically weight loss and insulin-sensitizing agents, successfully reduced diabetes incidence," explains Haw. "After medication or lifestyle intervention was stopped, we found that the effect of medications was short lived whereas the effect of lifestyle modification was sustained for several years, though it decreased over time" says Haw and Galaviz. This study suggests that lifestyle modification interventions that provide long-term support are needed to halt diabetes incidence worldwide.