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Type 2 diabetes: New study confirms the necessity of lifestyle changes

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(Vienna, 22 February 2020) Approximately 600,000 people in Austria suffer from Type 2 diabetes. Numerous drugs and insulin, amongst other things, are used to treat them, without sufficient attention being paid to the essential lifestyle changes required. In a study that was recently published in the specialist journal PLOS ONE, the researchers concluded that, if the universally accepted rules for the treatment of Type 2 diabetes were observed and imposed by all those involved, most patients could reach the desired therapeutic range in terms of weight, glucose and lipid metabolism and moreover, with the exception of Metformin and DPP 4 inhibitors, the additional administration of a large number of antidiabetic agents could be dispensed with.

The researchers studied 930 patients from a diabetes rehabilitation clinic on admission and immediately before they were discharged. During their three-week stay at the rehabilitation clinic, the patients got used to a modified lifestyle, consisting of a diet rich in vegetables and fruit with a total of 1200 to 1600 kcal per day, as well as an additional offering of physical exercise amounting to an output of 400 to 600 kcal per day.

On their discharge, as a result of these lifestyle changes, the patients no longer needed to take add-on antidiabetic agents, except for Metformin and DPP 4 inhibitors, and even those needing insulin managed to reduce their daily dose by an average of 39%. "These findings suggest that these lifestyle changes are preferable to prescribing a large number of add-on antidiabetic agents and might even be superior. Especially if you consider that it is impossible to get to the root of Type 2 diabetes and thereby solve it without making a lifestyle change," explains Principal Investigator Werner Waldhäusl, former Head of the Division of Endocrinology and Metabolism and Department of Medicine III of Vienna General Hospital and MedUni Vienna.

Moreover, the patients had had their blood glucose levels monitored over approximately two months and, at the time of discharge, their HbA1c levels had fallen by 7% on average, their blood pressure had fallen by 10% and their Body Mass Index and abdominal girth had each improved by an average of 3%. "These are significant results, confirming the efficacy and usefulness of Type 2 diabetes patients having a standardised stay in a rehabilitation centre for metabolic diseases," says Waldhäusl. "If you also consider that treatment in rehab clinics is usually significantly cheaper than in acute hospitals, the corresponding reallocation of patients would potentially give rise to significant savings for the healthcare system."

Diabetes does not make it more difficult to lose weight
In another parallel study, the researchers compared overweight patients with and without Type 2 diabetes. They found that the amount of weight loss achieved by both groups during the three-week stay in the rehabilitation clinic was more or less the same. "It is commonly assumed that it is more difficult for diabetics to lose weight than it is for other people. We were able to disprove this for Type 2 diabetes," explains Helmuth Haslacher from the Department of Laboratory Medicine of Vienna General Hospital and MedUni Vienna, who was also involved in the study. "I hope that this will encourage diabetics to make the necessary lifestyle changes."

A negative finding of the study, however, was that only a very small proportion (less than 9%) of the patients had been vaccinated against influenza and pneumococcal infections. "Especially for people with a chronic underlying disease such as diabetes, flu and pneumonia are very dangerous, often deadly, so that consistent vaccination coverage in this high risk group, as recommended worldwide in the guidelines of the corresponding professional societies, is urgently indicated," stresses Werner Waldhäusl.

The studies can be accessed at:
Type 2 diabetes care: Improvement by standardization at a diabetes rehabilitation clinic. An observational report; Helmuth Haslacher, Hannelore Fallmann, Claudia Waldhäusl, Edith Hartmann, Oswald F. Wagner, Werner Waldhäusl; PLOS ONE; December 2019; DOI

Obesity: outcome of standardized life-style change in a rehabilitation clinic. An observational study; Helmuth Haslacher, Hannelore Fallmann, Claudia Waldhäusl, Edith Hartmann, Oswald F. Wagner, Werner K. Waldhäusl; Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy; December 2019; DOI