CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 7, August 2013
292
AFRICA
to achieve at least a 7% weight loss, and
increase physical activity to 175 minutes
per week, implemented through group
and individual sessions.
In terms of cardiovascular effects of
intensive lifestyle interventions in type
2 diabetes, the trial was stopped for
futility reasons after a median follow up
of 9.6 years. The primary outcome was a
composite of death from cardiovascular
causes, non-fatal myocardial infarction,
non-fatal stroke, or hospitalisation for
angina during follow up.
An intensive lifestyle intervention
focusing on weight loss did not reduce the
rate of cardiovascular events in the study
population. However, it did show benefit
of a 31% reduction in the risk of advanced
kidney disease and a 14% reduction in the
risk of diabetic retinopathy. Also of note
was a 20% reduction in new incidence
of depression in the intensive lifestyle-
intervention arm.
Improvements in fitness levels saw
improvements in other markers of
metabolic risk, such as HbA
1c
levels
and systolic blood pressure. LDL
cholesterol levels were not improved
with the intensive lifestyle-intervention
programme.
The LookAHEAD research group. Cardiovascular
effects of intensive lifestyle intervention in type 2
diabetes.
N Engl J Med
2013;
369
: 145–154.
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t=1
Exercise may be the best
medicine for diabetes patients
Dr Samuel Dagogo-Black, professor
and director of Endocrinology, Diabetes
and Metabolism at the University of
Tennessee Health Science Centre, said
‘A preponderance of evidence mandates
lifestyle change, principally exercise
and diet, as the pre-eminent and primary
consideration for any and all purposes
where the goal is to improve insulin
sensitivity, reduce obesity and prevent
diabetes. The vast majority of overweight
people who are insulin resistant will
benefit greatly from a 5 to 10% weight
loss.’
Dr Dagogo-Black is also of the opinion
that there are very limited roles for drugs
and surgery. ‘Pharmacotherapy can help a
very select cohort of patients who fail to
respond to exercise and dietary changes,
whereas bariatric surgery is appropriate
for an even smaller and targeted cohort’.
Dr Barry Braun, associate professor
of Kinesiology at the University of
Massachusetts, stated that insulin
sensitivity is improved dramatically by
a single exercise session, and even more
by a three-month training programme.
Research into the effects of exercise and
metformin in patients with pre-diabetes
indicate that while exercise plus
metformin is not better than exercise
alone, the combination is better than
metformin alone.
Dr Paul Coen, assistant professor
of Health and Physical Activity at the
University of Pittsburgh, says that
exercise provides additional benefits to
cardiometabolic risk following bariatric
surgery. Experts recommend 150 minutes
of aerobic exercise a week; however any
amount of exercise is better than none.
New perspectives on type 2
diabetes risk factors
Epidemiological research continues to
uncover a growing list of novel risk factors
that include environmental elements.
Metals, plasticisers and air pollution are
not typically considered risk factors for
type 2 diabetes; however recent research
suggests they should be. Epidemiological
data have implicated environmental
exposure to arsenic and phthalates, both
common compounds used as plasticisers
across the globe, as risk factors for the
development of type 2 diabetes.
G Hardy
