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Cardio Diabetes Medicine 2017 617

The Role of Lifestyle Modification in The Prevention of

Diabetes and Cardiovascular Disease

Prof. Dr. Anand Moses MD, FRCP Dr. S. Charles Bronson
Emeritus Professor MBBS, D.Diab.(MMC), MRi,
The TN Dr MGR Medical University, Chennai Diabetologist,
Formerly Director and Professor, Institute of Diabetology,
Institute of Diabetology, Stanley Medical College & Hospital,
Madras Medical College & R.G. Govt. General Hospital, Chennai Chennai.

Diabetes – the epidemic: Furthermore, diabetes, per se, is considered as a
In recent years, diabetes mellitus (DM) has emerged ‘coronary heart disease risk equivalent’ by some au-
as a major public health problem throughout the thorities 11-13 while others differ on this concept.
world, with the number of people suffering being in Therefore, we must be able to grasp the concept that
hundreds of millions. India has the second highest ‘diabetes mellitus’ is not an isolated disorder, but
number of diabetes patients in the world, next only to rather it is part of a continuum, that is, the so-called
China. An estimated 69.2 million people have diabe- “Glycaemic continuum” which extends through the
tes in India. In terms of those with impaired glucose spectrum of IFG, IGT, DM and CVD.
tolerance (IGT), India tops the world with about 36.5
million people with IGT. 1 The importance of weight management:
Weight gain and obesity are known to be associat-
Diabetes and cardiovascular disease: ed with an increased incidence of insulin resistance
DM is a significant cause of cardiovascular (CV) mor- (IR) and T2DM. The Diabetes Prevention Program
bidity and mortality. The Framingham Heart Study (DPP) done in the United States has revealed that in
showed that the diabetes patient has a two to four those at risk of developing diabetes, a reduction in
times increased risk of developing myocardial infarc- body weight by 7% decreases the risk by about 58%.
2,3
2,4
tion, stroke, congestive cardiac failure, peripheral This reduction was higher than the reduction in risk
2,5
arterial disease and increased mortality due to cor- achieved with metformin therapy (31%).
onary heart disease. 2,3 Further, weight loss also helps to prevent CVD by
In the prediction of the progression from prediabetes reducing blood pressure (BP) and triglycerides (TGL)
to type 2 diabetes mellitus (T2DM), IGT has a high- which are risk factors for CVD.
er sensitivity than that of ‘impaired fasting glucose’ Aucott et al showed, in a systematic review, that los-
(IFG). 6,7 ing weight (intentional weight loss) by T2DM patients
Further, as seen in the Funagata Diabetes Study, IGT can decrease their risk of mortality by about 25%.
also is a risk factor for cardiovascular disease (CVD). Wing and co-workers showed that in overweight and
The Funagata study also pointed out that IFG, unlike obese individuals with T2DM, modest weight losses
IGT, is not a risk factor for CVD. Any degree of of about 5 to 10% produced significant improvements
7,8
glucose intolerance following a glucose challenge is in CVD risk factors. Greater weight losses produced
associated with atherosclerotic CV disease, mortality greater decrease in the risk factors of CVD. The
and morbidity. 7,9 magnitude of weight loss at 1 year was found to be
strongly associated with improvements in glycaemic
However it is noteworthy that Haffner et al had level, BP, TGL and HDL cholesterol, but not in LDL
shown in a subgroup analysis of the Scandinavian cholesterol (LDL-C) levels.
Simvastatin Survival Study population, that in those
patients with IFG who received simvastatin, signifi- Professional expert group guidelines thus recom-
cant reduction in major cardiovascular events and mend a reduction in body weight in overweight in-
mortality were observed. 7, 10 dividuals for the prevention as well as management

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