Diabetes type 2 patients who have been recently diagnosed and receive 6.5 hours of extra dietary advice have better sugar control than those with standard care, researchers from the University of Bristol, England, report in The Lancet. The authors wrote that additional dietary advice combined with more physical activity did not provide better results than standard care plus dietary advice.

Dr. Robert Andrews and team recruited 593 patients who had been diagnosed with type 2 diabetes within the previous 5 to 8 months – they were aged between 30 and 80 years.

They were randomly placed into three groups:

  • Standard care group – 99 received standard care. Included an initial dietary consultation plus a 6-monthly follow-up.
  • Dietary advice group – 248 received 6.5 hours of extra dietary advice. Included a dietary consultation every 3 months, plus monthly support form a nurse.
  • Combination group – 246 received 6.5 hours of dietary advice plus exercise. Same as dietary advice group, but they also did a 30-minute brisk walk five times per week (pedometers were used to check for compliance).

The scientists reported the following findings:

  • Standard care group – blood sugar got worse. Mean HbA1c rose from 6.72% to 6.86% over six months. At 12 months mean HbA1c dropped back to 6.81%.
  • Dietary advice group – Mean HbA1c dropped from 6.64% to 6.57% at six months and 6.55% at one year.
  • Combination group – similar to dietary advice group, with the exception of patients with a very high BMI (body mass index) or high insulin resistance.

The researchers wrote:

“These findings suggest that intervention at this early stage should focus on improving diet, since the additional cost of training health-care workers to promote activity might not be justified.”

The authors believe the addition of physical activity provided no apparent added benefits because perhaps the study was not long enough, or the activity needed to be more intensive. There is also the possibility that those doing the brisk walks rewarded themselves afterwards with extra food, they added.

The scientists concluded:

“Further research is needed to clarify whether more intensive or different types of activity, or activity advice offered at a later stage of diabetes will add benefits to diet interventions, or whether benefits of activity interventions will become more apparent after 1 year.”

Although the HbA1c changes in this study were fairly small, they are still clinically meaningful, Dr Frank B Hu, Harvard School of Public Health, Boston, wrote. A 1% drop in HbA1c reduces the risk of major cardiovascular disease by between 12% and 16%, and microvascular complications by 37%.

Dr. Hu concluded:

“Translation of these results into community settings requires concerted efforts by patients, dietitians, and clinicians… There is little doubt that improved nutrition and physical activity are beneficial for individuals with or without diabetes, and research into the most effective way to deliver these benefits (including individual behavioural changes and creation of a supportive food and social environment) deserves high priority.”

“Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial”
Dr RC Andrews PhD, AR Cooper PhD b, AA Montgomery PhD, AJ Norcross MSc, Prof TJ Peters PhD, Prof DJ Sharp PhD, N Jackson BSc, K Fitzsimons PhD, J Bright MBA, K Coulman MSc, CY England BSc, J Gorton BSc, A McLenaghan RN, E Paxton BSc, A Polet BSc, C Thompson Dip HE, Prof CM Dayan FRCP
The Lancet, Early Online Publication, 25 June 2011. doi:10.1016/S0140-6736(11)60442-X

Written by Christian Nordqvist