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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Intensive dietary advice in early diabetes

The Lancet has published the results of a study that aimed to assess the impact of lifestyle changes soon after diagnosis with type 2 diabetes mellitus.

This study compared usual care with intensive dietary advice (an additional 2 hours with a dietician and 4.5 hours with a nurse over 12 month) or intensive dietary advice with physical activity (a pedometer-based activity programme). The study recruited 593 eligible individuals (99 were assigned usual care, 248 the diet regimen and 246 diet plus activity). Patient were followed up for blood pressure and glucose measured by HbA1c. The study ran for 12 months.

At 6 months, HbA1c had worsened in the usual care group but improved in both intervention groups compared to the baseline mean. The difference between the intervention groups and the usual care group was statistically significant in both cases. (Diet alone –0·28, 95% CI –0·46 to –0·10, p=0·0049, Diet and physical activity –0·33, 95% CI –0·51 to –0·14, p=0·0009). These improvements persistent until the 12 month follow up. There was no additional improvement noted in the group who were randomised to physical activity. Blood pressures remained similar in all groups.

It was also noted that the intervention groups experienced weight loss and had a lesser need for medication compared to individuals in the usual care group.

The authors conclude that, "an intensive diet intervention soon after diagnosis can improve glycaemic control".

Action: Clinicians should be aware of this study. This study adds support to the patient education and dietary advice recommendations made in the Diabetes Clinical Guideline from NICE. Clinicians can now assure patients that lifestyle interventions are of proven benefit.

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