Blood Sugar & Diabetes

TLC Programs: FirstLine Therapy®: Chronic Illness: Blood Sugar & Diabetes

Blood Sugar Management and Diabetes

Insulin Resistance and Type 2 Diabetes

According to the National Institutes of Health Diabetes Education Program, diabetes affects one out of every 14 people. Of those, 90% to 95% have type 2 diabetes.¹ Just how big a problem is diabetes?

In all age groups, total prevalence of diabetes was 20.8 million people, or 7% of the population.²
Heart disease and stroke account for about 65% of deaths in people with diabetes, and about 73% of adults with diabetes have blood pressure greater than or equal to 130/80 mmHg or use prescription medications for hypertension.²
Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.²
Diabetes accounts for 44% of new cases of kidney failure.²
More than 60% of non-traumatic lower-limb amputations occur among people with diabetes.²

Chances are that some of your patients are at risk for type 2 diabetes. Therefore, it’s crucial to help them maintain healthy blood glucose levels.

Natural Patient Protection

Now for some good news. Clinical studies suggest that therapeutic lifestyle change (TLC) programs can help support healthy blood glucose levels and guard against insulin resistance.
Even small adjustments can lead to big improvements. For instance, patients can:

Eat a healthier diet. Research suggests that a diet rich in whole grains, legumes, and vegetables (especially the dark-green leafy variety) is not only a good source of essential nutrients and fiber but also has a beneficial effect on blood lipids and blood pressure.
Start a daily exercise regimen. Exercise will help patients build muscle and increase the body’s metabolic rate, enabling them to burn calories more effectively. Even low- to moderate-intensity activities such as walking the dog, stair climbing, and gardening can provide significant benefits.
Take quality supplements. Supplementing a healthier diet with certain nutrients—at doses that are difficult to obtain from diet alone—may be beneficial in supporting overall health.
Learn to manage stress. Change of any kind, even if beneficial, is stressful. Eating in response to stress (i.e., "emotional" eating) can undo all of a patient’s good dietary and fitness efforts. For these and other reasons, stress management techniques such as breathing exercises, meditation, massage, and yoga are invaluable for good health.

The Evidence is In: TLC Works…

… for Men and Women of all Ages

Therapeutic lifestyle intervention—specifically, a healthy diet and physical activity—was evaluated in a randomized clinical trial of 67 adults (38 men; 29 women) aged 24-75 years with impaired glucose tolerance (IGT). Published in Diabetes Research and Clinical Practice,3 this study evaluated outcome changes between baseline and 6 months. Significant differences resulted for those who adopted TLC.

The body mass index (BMI) and serum insulin levels in the TLC participants significantly improved over the control groups (p=0.001 and p=0.005, respectively).
Elevated NEFA (non-esterified fatty acids) concentrations are frequently found in insulin resistant individuals, and the results showed that fasting plasma NEFA concentrations decreased significantly in intervention (TLC) but not control participants.

Conclusion: Therapeutic lifestyle interventions can result in reduced risk factors for coronary heart disease (CHD) and type 2 diabetes.

… for Insulin-Resistant Patients

Another randomized, controlled study published in Diabetes Care compared the effect on insulin sensitivity of current dietary and exercise recommendations with a more intensive therapeutic lifestyle intervention in 79 normoglycemic, insulin-resistant men and women.⁴ The results were significant.

Only the intensive group—the group following a TLC program—showed a significant improvement in insulin sensitivity (23% increase, p=0.006 versus 9% in the modest group, p=0.23).
This finding was linked with a significant improvement in aerobic fitness (11% increase in the intensive group, p=0.02 versus 1% in the modest group, p=0.94).
The authors commented that weight loss and diet composition may have also played an important role in how participants fared in terms of insulin sensitivity.

Conclusion: Current clinical dietary and exercise recommendations, even when vigorously implemented, did not significantly improve insulin sensitivity—but a more intensive TLC program did.

… for Overweight Patients

In a study published by the New England Journal of Medicine, 522 middle-aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean BMI, 31) with impaired glucose tolerance were randomly assigned to either a therapeutic lifestyle intervention or control group.⁵ After 3.2 years, the study showed that participants who followed a TLC program benefited significantly.

The net weight loss by the end of year 2 was 3.5 kg (7.7 lbs) in the intervention (TLC) group and 0.8 kg (1.76 lbs) in the control group (p<0.001).
The cumulative incidence of diabetes after 4 years was 11% in the intervention group and 23% in the control group.
During the trial, the risk of diabetes decreased by 58% (p<0.001).

Conclusion: Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.

… for Elderly Patients

A cohort study published in the Journal of the American Geriatrics Society looked at how therapeutic lifestyle interventions (TLC) influenced metabolic syndrome in elderly men.⁶ Study participants consisted of 3,051 men aged 60-79 years with no diabetes mellitus or diagnosis of CHD. TLC made a significant difference in this study, too.

Overweight/obesity and physical inactivity were associated with a significantly higher risk of the metabolic syndrome, as were cigarette smoking and a high-carbohydrate diet.
Physical activity and losing weight in the previous 3 years were correlated with a lower risk of the metabolic syndrome.

Conclusion: Modifying lifestyle factors, even later in life, has considerable potential for primary prevention of metabolic syndrome.

FirstLine Therapy®—Better Health Now and for a Lifetime

FirstLine Therapy (FLT) is a TLC program developed to help patients address the underlying causes of disease and lead a healthier, more vibrant life. The basic principles of FLT—low-glycemic-load eating plan, regular exercise, nutritional supplementation, and stress management—are the foundation upon which you can build a program tailored to your patients’ specific needs and build your practice at the same time.

Put Patients on the Path to Better Health Today!

The time to return your patients to healthy blood glucose levels is now! Learn more about FirstLine Therapy and the FirstLine Therapy Certification Program click here.

REFERENCES

National Diabetes Education Program, National Institutes of Health. http://ndep.nih.gov/diabetes/pubs/Diabetes_The_Numbers_Jan2007.ppt. Accessed February 25, 2008.
National Diabetes Statistics. http://diabetes.niddk.nih.gov/dm/pubs/statistics/#7. Accessed December 10, 2007.
Oldroyd JC, Unwin NC, White M, et al. Randomized controlled trial evaluating the effectiveness of behavioural interventions to modify cardiovascular risk factors in men and women with impaired glucose tolerance: Outcomes at 6 months. Diabetes Res Clin Pract. 2001;52(1):29-43.
McAuley KA, Williams SM, Mann JI, et al. Intensive lifestyle changes are necessary to improve insulin sensitivity: a randomized controlled trial. Diabetes Care. 2002;25(3):445-452.
Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-1350.
Wannamethee SG, Shaper AG, Whincup PH. Modifiable lifestyle factors and the metabolic syndrome in older men: effects of lifestyle changes. J Am Geriatr Soc. 2006;54(12):1909-1914.