Approx. 290,000 Danes suffer from type 2 diabetes. A remarkable new study shows that physical activity can be as effective as medicine in treating this widespread disease. Half of the patients participating in the Danish type 2 diabetes study, known as the U-TURN study, stopped taking their medicine one year after changing their lifestyle. The new findings challenge existing type 2 diabetes treatment. The results of the study have just been published in the prestigious Journal of the American Medical Association (JAMA). The treatment usually prescribed for people with type 2 diabetes is medicine and lifestyle advice. In the U-TURN study, a group of researchers from TrygFonden's Centre for Physical Activity Research (CFAS) at Rigshospitalet investigated whether intensive lifestyle changes, focussing in particular on physical activity, can be as effective as standard diabetes treatment.
The new study showed that this was very much the case: A surprising three out of four (73%) of the participants reduced their need for antidiabetic medicines as a result of the one-year study on lifestyle change. More than half (56%) of the participants made so much progress that they no longer had to take their medicine, and at the same time their blood-sugar control improved.
- It came as a surprise that the lifestyle intervention seemed to be more effective than medicine in lowering blood glucose levels, and that it also resulted in a significant decline in the need for blood glucose-lowering medicine, said Mathias Ried-Larsen, one of the primary authors of the study and Group Leader at the CFAS and the Danish Diabetes Academy.
Bente Klarlund, MD and Professor at the CFAS added:
- These results challenge our perception of type 2 diabetes as a disease you'll never get rid of. And it challenges our practice with regard to offering patients the best possible treatment.
Medicine and physical activity: not a question of either/or
Lifestyle guru Chris MacDonald is part of the research group working on the large-scale diabetes study. He also coached the participants in the lifestyle television programme "U-TURN 2 - et liv uden piller" (U-TURN 2 - a life without pills) broadcast on Danish national television in the spring. The programme was related to the large-scale research study.
- I'm very happy that this study has provided scientific evidence for the huge potential of a healthy lifestyle. Something I've observed in my work for many years. It's amazing that patients facing lifelong medical treatment can now stop taking their medicine and replace it with physical training and a healthy diet, while at the same time maintaining normal blood-sugar levels. This is certainly food for thought. But we have to be careful not to think in terms of either medical treatment or lifestyle intervention in relation to type 2 diabetes patients. It's not a question of either/or: both are important.
The study does not in any way give 'carte blanche' for type 2 diabetes patients (or other patients) to stop taking their medicine without close monitoring by their physician.
- Medicine remains an essential part of type 2 diabetes treatment," explained Mathias Ried-Larsen. "In our investigation, all participants were monitored very closely, and their medicine was only reduced if they demonstrated that they could maintain acceptable long-term blood glucose levels over a long period of time. If the long-term blood glucose level increased, medical treatment was intensified."
Training 5-6 times a week
The lifestyle group had 5-6 training sessions per week for 12 months, and at the same time an antidiabetic diet was prescribed. At the beginning, all training sessions were performed with a physical trainer present, but the participants were gradually given more responsibility themselves. Mette Yun Johansen, a PhD student at the CFAS and responsible for lifestyle intervention admitted that the intensive training programme could discourage some participants:
- All these training sessions may be a radical change, but experience from the study shows that, if we create a good framework with the right supervision and support, what may seem impossible at first can actually be accomplished by a lot of people. Therefore, we have to focus finding a manageable way to reach out to a lot of people.
Whether intensive lifestyle treatment will become an actual treatment programme in line with medical treatment depends on the results of future studies. Mathias Ried-Larsen added that: "Our study shows that we need to focus on the importance of lifestyle in clinical diabetes treatment. We have to look at the long-term effects before we can offer lifestyle intervention as an alternative to medical treatment."
- According to the Danish Diabetes Association, 290,000 Danes suffer from type 2 diabetes. Another 750,000 have early stage type 2 diabetes.
- The National Institute of Public Health estimates that the number of type 2 diabetes patients will double by 2030.
- According to the Danish Diabetes Association, diabetes (type 1 and type 2) costs Danish society DKK 86 million a day.