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622 The Role of Lifestyle Modification in The Prevention of
Diabetes and Cardiovascular Disease

group. In the Chinese Da Qing study, the participants or delay the onset of T2DM and consequently its

had IGT. The subjects were assigned to one of the 4 complications like CVD.
groups – Control, Diet only, Exercise only and Diet
plus Exercise. The follow-up period was for 6 years. References:
The Diet only, Exercise only and Diet plus Exercise 1. International Diabetes Federation. IDF Diabete Atlas, 7 ed. Brussels, Bel-
groups had 31%, 46% and 42% reductions, respective- gium: International Diabetes Federation, 2015. http://www.diabetesatlas.
ly, in the risk of developing T2DM. org
The Diabetes Prevention Program Outcomes Study 2. Fox CS. Cardiovascular Disease Risk Factors, Type 2 Diabetes Mellitus, and
the Framingham Heart Study. Trends Cardiovasc Med. 2010; 20(3):90-5.
(DPPOS) was a follow-up of the DPP where the orig- doi: 10.1016/j.tcm.2010.08.001.
inal metformin group was continued with metformin
treatment and the original lifestyle group was given 3. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Fram-
ingham study. JAMA. 1979; 241: 2035-38.
additional lifestyle modification support. The study
showed that there was a sustained reduction in the 4. Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart
failure: the Framingham study. Am J Cardiol. 1974; 34: 29–34.
incidence of T2DM by 34% in the lifestyle group and
18% in the metformin group at the end of 10 years 5. Brand FN, Abbott RD, Kannel WB. Diabetes, intermittent claudication,
and risk of cardiovascular events. The Framingham Study. Diabetes. 1989;
33
since randomisation for the DPP. In the follow-up of 38:504–509.
the Finnish DPS and the Chinese Da Qing study, 43%
reduction at 7 years and 43% reduction at 20 years 6. Shaw JE, Zimmet PZ, De Courten M, Dowse GK, Chitson P, Gareeboo H,
et al. Impaired Fasting Glucose or Impaired Glucose Tolerance- What best
respectively were observed in the incidence of T2DM. predicts future diabetes in Mauritius? Diabetes Care. 1999; 22: 399-402.
In the Indian Diabetes Prevention Programme (IDPP), 7. Moses A, Bronson SC, Moses VS. Pharmacotherapy for management of
the participants were divided into groups. Group 1 was prediabetes. In: Madhu SV, editor-in-chief. RSSDI Diabetes Update 2016.
the control group. Group 2 was given advice on life- New Delhi: Jaypee Brothers medical publishers (P) Ltd. ; 2017. 375 -77.
style modification (LSM), group 3 was treated with 8. Tominaga M, Eguchi H, Manaka H, Igarashi K, Kato T, Sekikawa A. Im-
metformin (MET) and group 4 received both LSM and paired Glucose Tolerance is a risk factor for cardiovascular disease, but
not Impaired Fasting Glucose – The Funagata Diabetes Study. Diabetes
metformin (LSM+MET). The median follow-up period Care. 1999; 22:920–924.
was 30 months. The reduction in risk of diabetes 9. Perry RC, Baron AD. Impaired Glucose Tolerance. Why is it not a disease?
was 28.5% in the LSM group, 26.4% in the MET group Diabetes Care. 1999; 22: 883-885.
and 28.2% in the LSM+MET group as compared to
the control group. These reductions are seemingly 10. Haffner SM, Alexander CM, Cook TJ, Boccuzzi SJ, Musliner TA, Pedersen

TR, et al. Reduced coronary events in simvastatin-treated patients with
lesser than those observed in the American, Finnish coronary heart disease and diabetes or impaired fasting glucose levels:
and Chinese studies. In the IDPP, the lifestyle advice subgroup analyses in the Scandinavian Simvastatin Survival Study. Arch
& modification administered were less intense than Intern Med. 1999; 159:2661-7.
that given in the DPP and Finnish DPS, and exercise 11. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from
was not supervised. Further, the relatively lesser risk coronary heart disease in subjects with type 2 diabetes and in nondiabetic
reduction of T2DM in the Chinese and Indian studies subjects with and without prior myocardial infarction. N Engl JMed 1998;
339: 229-34.
when compared to the American and Finnish studies
may also be reflective of and due to the higher inci- 12. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cho-
lesterol in Adults. Executive summary of the third report of the national
dence of T2DM in the population in these countries . cholesterol education program (NCEP) Expert panel on detection, evalu-
ation, and treatment of high blood cholesterol in adults (adult treatment
Conclusion: panel III). JAMA. 2001; 285 :2486-97.
Diabetes affects the individual, his family and the 13. Rana JS. Is Diabetes really a CHD risk equivalent. Expert Opinion.
society in terms of physical, emotional, familial, eco- 2016 Apr 13. American College of Cardiology website. Accessed on
2017 Sep 6. Available from: http://www.acc.org/latest-in-cardiology/arti-
nomical and socio-cultural stress and burden. India cles/2016/04/12/13/40/is-diabetes-really-a-chd-risk-equivalent
has a higher prevalence of T2DM & IGT and the pop- 14. Rydén L, Grant PJ, Anker SD, et al. ESC Guidelines on diabetes, pre-diabe-
ulation is prone to develop dysglycaemia. Hence, as tes, and cardiovascular diseases developed in collaboration with the EASD:
for as India is concerned, not only those with predi- the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of
abetes & other high risks for developing diabetes, the European Society of Cardiology (ESC) and developed in collaboration
but also the whole population in general needs to with the European Association for the Study of Diabetes (EASD). Eur
Heart J. 2013; 34(39): 3035-87. doi: 10.1093/eurheartj/eht108. Epub
be targeted to prevent T2DM and reduce the burden. 2013 Aug 30.
Therefore, in such a scenario, a well motivated and
sustained lifestyle modification will definitely prevent 15. Guess N. Lifestyle issues: Diet. In: Holt RIG, Cockram CS, Flyvbjerg A,
Goldstein BJ, editors. Textbook of Diabetes. 5 ed. Chichester, West Sus-
th
sex, UK: Wiley Blackwell; 2017. 341-52.

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