Correspondence

Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle

N Engl J Med 2001; 345:696-697August 30, 2001

Article

To the Editor:

Tuomilehto et al. (May 3 issue)1 reported that counseling subjects at high risk for type 2 diabetes mellitus to reduce weight and the intake of fat and to increase physical exercise and the intake of fiber reduced the risk of diabetes by 58 percent, as compared with the risk in a usual-care group. We would like to know whether the weight loss in the intervention group was maintained throughout the follow-up period (i.e., at six years of follow-up). Most subjects in weight-loss programs have been unable to sustain weight loss, and in several studies more than 90 percent of subjects who lost weight eventually returned to their original weight.2,3

We also wonder what kind of antihypertensive drugs were prescribed in the intervention and control groups. In particular, we would like to know how many of the patients in the two groups received an angiotensin-converting–enzyme (ACE) inhibitor, which according to the Heart Outcomes Prevention Evaluation (HOPE) trial is associated with a decrease in the incidence of diabetes mellitus.4

J. George Fodor, M.D., Ph.D.
Kristi B. Adamo, M.Sc.
University of Ottawa Heart Institute, Prevention and Rehabilitation Centre, Ottawa, ON K1Y 4W7, Canada
gfodor@ottawaheart.ca

4 References

1. 1

   Tuomilehto J, Lindstrom J, Eriksson J, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343-1350
   Full Text | Web of Science | Medline

2. 2

   Friedman JM. Obesity in the new millennium. Nature 2000;404:632-634
   Web of Science | Medline

3. 3

   Wadden TA. Treatment of obesity by moderate and severe caloric restriction: results of clinical research trials. Ann Intern Med 1993;119:688-693
   Web of Science | Medline

4. 4

   The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000;342:145-153[Erratum, N Engl J Med 2000;342:748, 1376.]
   Full Text | Web of Science | Medline

To the Editor:

More than two thirds of the subjects in the study by Tuomilehto et al. were women, and therefore the role of gestational diabetes, a major risk factor for the subsequent development of type 2 diabetes, should not be overlooked.1 How many women in the study had a history of gestational diabetes, and were these women equally distributed between the intervention and usual-care groups?

Oren Fruchter, M.D.
29 Greenbaum St., 34987 Haifa, Israel
oren_md@inter.net.il

1 References

1. 1

   Kjos SL, Buchanan TA. Gestational diabetes mellitus. N Engl J Med 1999;341:1749-1756
   Full Text | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: We agree that the maintenance of weight loss is difficult. The subjects in the intervention group did regain some weight in the later years of our study, but they remained leaner than the control group. Thus, the difference in weight loss between the intervention and control groups was 2.7 kg after two years and 2.1 kg after five years of follow-up.

Post hoc analyses of trials with the ACE inhibitor ramipril1 and the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor pravastatin have suggested that treatment with these drugs reduces the risk of diabetes mellitus.2 In our study, the proportion of subjects receiving any antihypertensive drug at base line was 30 percent in the intervention group and 31 percent in the control group. The proportion of subjects receiving cholesterol-lowering drugs at base line was also similar in the two groups. The number of subjects in both groups who were receiving both types of drug increased during the study; 13 percent of the subjects received an ACE inhibitor and 15 percent received an HMG-CoA reductase inhibitor in the intervention group, as compared with 14 percent and 15 percent, respectively, in the control group. Thus, the outcome in our trial was not confounded by differences in treatment with antihypertensive or cholesterol-lowering drugs.

The prevalence of gestational diabetes was similar in the two groups. A total of 37 women (13 percent), 20 in the intervention group and 17 in the control group, reported a history of gestational diabetes.

Jaakko Tuomilehto, M.D., Ph.D.
Jaana Lindström, M.S.
Timo T. Valle, M.D.
National Public Health Institute, 00300 Helsinki, Finland
jaakko.tuomilehto@ktl.fi

2 References

1. 1

   The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000;342:145-153[Erratum, N Engl J Med 2000;342:748, 1376.]
   Full Text | Web of Science | Medline

2. 2

   Freeman DJ, Norrie J, Sattar N, et al. Pravastatin and the development of diabetes mellitus: evidence for a protective treatment effect in the West of Scotland Coronary Prevention Study. Circulation 2001;103:357-362
   Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   P. M. Magalhães, H. J. Appell, J. A. Duarte. (2008) Involvement of advanced glycation end products in the pathogenesis of diabetic complications: the protective role of regular physical activity. European Review of Aging and Physical Activity 5:1, 17-29
   CrossRef