If you have any doubt about whether eating right and exercising will help fend off the effects of diabetes, think again.
A 10-year extension of the original study that proved the effectiveness of such lifestyle choices not only reaffirmed those conclusions, but found they reduced complications as well, officials said Monday.
"The results in Hawaii and elsewhere across the country provide real hope that acting early and preventing diabetes can have lasting effects," said Dr. Richard Arakaki, a University of Hawaii expert in diabetes and endocrinology, and principal investigator leading the Hawaii trial.
The UH John A. Burns School of Medicine was one of 27 clinics across the country that led clinical trials aimed at determining the best prospects for preventing the deadly disease.
It turns out that increasing physical activity effectively prevented or delayed the development of Type 2 diabetes for 16 years spanning the original federally funded study, a break of several years and the recently concluded follow-up, the Diabetes Prevention Program Outcomes Study, which was designed to examine the longer-term impact of the original treatments.
According to the study’s findings, risk factors for heart disease were reduced for participants, as were the development of kidney, nerve and eye complications. A healthier lifestyle was also found to reduce the need for medications treating diabetes, high blood pressure and abnormal cholesterol levels.
"Eat healthy, folks," said Leroy Piiohia, who was one of 72 people from Hawaii enrolled in the original group in 1994.
"I was at high risk when I first came in (to the study)," said Piiohia, who did eventually come down with diabetes. "I learned about nutrition and better ways to eat. Thanks to the nutrition I learned at the start of the program, I eat everything I want but in (smaller) quantities. I watch what I eat."
The study followed participants who were randomly placed in different groups, including a group for people who changed their lifestyles to reduce weight and increase physical activity and a group that took the diabetes drug metformin.
The greatest success came from those in the lifestyle group, which saw a 27 percent reduced risk of diabetes. The group that was given metformin experienced a 17 percent reduced risk of diabetes compared with a placebo group.
Nationally, with more than 3,800 participants, the results were even better. The incidence of diabetes was reduced by 43 percent in the lifestyle group and 18 percent in those taking metformin compared with the placebo group.
"Diabetes is still a burden in our community. It’s serious. It’s also common," Arakaki said. "Twenty-nine million Americans have diabetes, and 81 million have pre-diabetes. The number is growing in epidemic proportions, and so we need to do more."
The cost of diabetes is rising faster than any other disease: $245 billion in 2012. Diabetes medications cost $30 billion in 2012, with a projected cost of $50 billion in 2018.
More than 113,000 people in Hawaii have been diagnosed with diabetes, with an estimated 26,100 remaining undiagnosed. Recent estimates project that as many as 1 in 3 American adults will have diabetes in 2050.
"Preventions should be broadly adopted and widely implemented," Arakaki declared.
Mae Isonaga, dietitian and Hawaii program co-coordinator, said members of the lifestyle group were asked to consume a low-fat diet consisting of vegetables, fruits and whole grains. They were also advised to eat whole foods rather than processed foods.
The lifestyle group was also asked to exercise 150 minutes a week, or 30 minutes five days a week, she said. That included walking, but some here fulfilled their exercise requirement by surfing, paddling and hula dancing.
"We thought we would do well with the exercise activities because of the weather here," Arakaki said. "But as it turns out, we didn’t do as well. It seems life in general got in the way."
Even so, after 16 years, participants in both groups lowered weights on average compared with a placebo group, with 60 percent of the lifestyle group remaining below their start weight 16 years ago, he said.
Joy Gold, another study participant, said the biggest challenge for her was doing the physical activity. She had been involved in sports as a youth, but it became less of a priority as she grew older.
"It’s harder as an adult now to get more engaged, even if it’s walking five days a week for half an hour," she said.
Her advice to young people: "Continue to be active."
Alfred Batungbacal credited the program with helping him avoid coming down with diabetes altogether.
"I was high risk from the start," he said. "I learned things I had no idea about nutrition and all that."
Batungbacal said the exercise was a challenge from the start.
"I thought I was going to quit within those first two months," he said, recalling how exhausted he was after exercising. "It didn’t show any difference (in weight loss) the first three or four months. I thought, ‘Oh, my God, I’ll never do this.’ But it’s worked real well."
Piiohia admitted he eats ice cream almost every night.
"But by watching my diet, I make room for that. Life’s too short."
