Dietary advice improves diabetes over and above drugs

Helping people with high-risk type 2 diabetes follow a healthier diet significantly improves their blood sugar control beyond what medication can achieve alone, according to latest University of Otago research.

Study lead author Dr Kirsten Coppell says the research indicates that providing intensive evidence-based dietary advice could help people with diabetes stave off the disease's often devastating and life-shortening complications.

Findings from the six-month lifestyle intervention trial involving New Zealand patients with poorly controlled diabetes, which was led out of the University's Edgar National Centre for Diabetes Research, appear in the prestigious UK medical journal BMJ.

Dr Coppell says ensuring diabetes patients can maintain satisfactory control over their blood sugar levels is crucial in avoiding long-term complications such as kidney failure, heart disease, gangrene and blindness.

"The patients in our study were already under intensive drug treatment to optimise their glycaemic control, which remained unsatisfactory. We found that by also following carefully tailored dietary advice they could significantly improve this control," Dr Coppell says.

Given the tendency for glycaemic control in high-risk diabetes patients to slowly but surely deteriorate – no matter how intensive their drug treatment – the findings are highly relevant for improving diabetes management, she says.

The study divided 94 such diabetes patients from the Otago region into two groups.

Over six months both received optimised medical care, but patients in one of the groups were also given regular one-on-one dietary advice from a dietitian.

Measures of glycaemic control were found to have significantly improved in the group receiving the advice, with some members even able to safely reduce their doses of hypoglycaemic drugs or insulin by the end of the study period, she says.

"Since the widespread introduction of anti-diabetic drugs, the traditional focus on diet and lifestyle in managing diabetes has faded into the background. Our findings suggest that there needs to be a renewed focus on these elements if we want to improve diabetes outcomes," she says.

Dr Coppell says significant reductions in weight, body mass index and waistlines also occurred in the nutritional advice group, with an average weight loss of 2.1 kg and a 3cm reduction in waistlines achieved.

Rather than focusing on a strict diet, advice was tailored to match each individual's socio-economic and cultural circumstances. It involved elements such as encouraging smaller meals, reducing unhealthy components in their diets while eating more fruit and vegetables.

Dr Coppell says the study shows that modifying eating habits on top of medication could have important benefits for diabetes patients.

"However, making and sustaining such lifestyle changes can be difficult for many people. Having specialist health professionals who can assess individual circumstances and provide regular advice and encouragement, as well as supportive family members, appears to be a key factor to succeeding in this."

Accordingly, the research's ultimate goal is to develop an appropriate programme, involving such experts, which could be put in place to improve the health of the hundreds of thousands of people in New Zealand living with type 2 diabetes, she says.

The study, called Lifestyle Over and Above Drugs in Diabetes (LOADD), was supported by grants from the Health Research Council of New Zealand and the Southern Trust. Diabetes New Zealand Inc. allowed the researchers use of dietary resources published by the organisation.

(Source: University of Otago: BMJ: August 2010)