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VOLUME 17 NUMBER 2 • NOVEMBER 2020
63
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Diabetes News
A few kilograms’ weight loss nearly halves the risk of diabetes:
large UK clinical trial
L
osing a few kilograms in weight almost
halves people’s risk of developing type 2
diabetes, according to a large-scale research
study led by the Norfolk and Norwich
University Hospital and the University of
East Anglia, published in
J Am Med Assoc
Internal Medicine
. The study shows how
providing support to help people with
pre-diabetes make small changes to their
lifestyle, diet and physical activity can almost
halve the risk of developing type 2 diabetes.
The findings come from the Norfolk
Diabetes Prevention Study (NDPS), the
largest diabetes-prevention research study
in the world in the last 30 years. The NDPS
clinical trial ran over eight years and involved
more than 1 000 people with pre-diabetes
at high risk of developing type 2 diabetes.
The study found that support to make
modest lifestyle changes, including losing
two to three kilograms of weight and
increased physical activity over two years,
reduced the risk of type 2 diabetes by 40
to 47% for those categorised as having
pre-diabetes. There are about eight million
people with pre-diabetes in the UK and
4.5 million have already developed type 2
diabetes.
The NDPS, funded by £2.5m from the
National Institute for Health Research
(NIHR), and NIHR CRN Eastern, was led by
the Norfolk and Norwich University Hospital
(NNUH) and University of East Anglia (UEA),
together with colleagues from Ipswich
Hospital, and the universities of Birmingham
and Exeter. The research trial tested a simple
lifestyle intervention, which helped people
make small, achievable lifestyle changes that
led to a modest weight loss, and increases in
physical activity.
Importantly these changes were
sustained for at least two years and the
weight lost was not put back on. These
findings are important as they show that a
‘real-world’ lifestyle programme really can
make a difference in helping people reduce
their risk of type 2 (adult-onset) diabetes.
Prof Mike Sampson, NDPS chief
investigator and consultant in diabetes at
NNUH, said: ‘We are delighted with the
results of this trial, as until now no one was
very sure if a real-world lifestyle programme
prevented type 2 diabetes in the pre-diabetes
population we studied, as there have been
no clinical trials that had shown this.
‘We have now shown a significant effect
in type 2 diabetes prevention, and we can be
very optimistic that even a modest weight
loss, and an increase in physical activity, in
real-world programmes like this have a big
effect on the risk of getting type 2 diabetes.
‘This is really great news for the eight
million people in the UK with a pre-diabetes
diagnosis. The results of this trial show that
diabetes prevention is possible in the same
pre-diabetes populations being treated
in the NHS national diabetes prevention
programme. ‘This is important to know, as
the clinical methods for diagnosing diabetes
and pre-diabetes have changed a lot in
recent years.’
The Norfolk Diabetes Prevention Study
ran between 2011 and 2018 and worked
with 135 GP practices in the east of England,
and found 144 000 people who were at risk
of developing type 2 diabetes. In screening
sites across the east of England, 13 000 of
these people then took a fasting glucose
and glycosylated haemoglobin (HbA
1c)
blood
test to detect pre-diabetes.
More than 1 000 people with pre-diabetes
were then entered into a randomised,
controlled trial, testing a pragmatic real-
world lifestyle intervention, compared to
a control group, with average follow up
of just over two years. Earlier studies have
used quite intense and expensive research
interventions in different groups of pre-
diabetes participants, but this is the first time
a real-world group-delivered intervention
has been shown to reduce the risk of type
2 diabetes.
NDPS also asked lay members of the
public who had type 2 diabetes themselves
to help support participants with pre-
diabetes in the trial, but for this particular
population, this did not further reduce the
risk of getting type 2 diabetes.
NDPS co-investigator Prof Bachman,
from Norwich Medical School, is part of
UEA’s Norwich Institute of Healthy Ageing,
a new research centre investigating how we
can live longer, healthier and more satisfying
lives.
He said: ‘The NDPS intervention
was delivered in groups, which was far
less expensive than individual-focused
interventions that have previously shown
to be effective under optimal conditions.
For every 11 people who received the NDPS
intervention, one person was prevented
from getting type 2 diabetes, which is a real
breakthrough.’
Prof Colin Greaves from the University
of Birmingham, who jointly led the
development of the NDPS intervention,
said: ‘If you have been diagnosed with pre-
diabetes, this approach offers a way to take
a different direction in your life – to get off
the path to type 2 diabetes and onto the
road to a healthier future.’
Dr Jane Smith, NDPS collaborator from
the University of Exeter, said: ‘Type 2 diabetes
is a huge health challenge globally. NDPS is
an incredibly positive story for individuals
and healthcare systems, and underlines the
importance of providing national diabetes-
prevention programmes, which can use our
research findings.’
Prof Jonathan Valabhji, national clinical
director for diabetes and obesity for NHS
England, said: ‘This study with similar
referral criteria and a similar intensive
lifestyle intervention to the NHS Diabetes
Prevention Programme has surpassed
expectations in preventing type 2 diabetes.
This is hugely encouraging for the NHS
Diabetes Prevention Programme, and what
participants might expect to achieve in the
longer term.’
Dr Elizabeth Robertson, director of
research at Diabetes UK, said: ‘We welcome
this new research showing that a group-
based support programme can help people
at high risk of developing type 2 diabetes
reduce their risk. This trial again highlights
how achieving modest weight loss through
diet and physical activity changes can lead
to huge benefits for people at high risk of
developing type 2 diabetes. Type 2 diabetes
is a serious condition, but with the right help,
many cases can be prevented or delayed.’
‘Diabetes UK’s “Know Your Risk” tool
helps people to determine their risk and take
steps to reduce it, including by self-referring
on to NHS England’s Diabetes Prevention
Programme in their local area.’
Source:
Medical Brief
2020