Benefits of Nutritional Counseling in Diabetes Prevention

The hardest part about marketing a preventive service is that results, though evident, require patience. Ingesting a medicine feels like a much more active method of treatment than making gradual lifestyle changes. Swallowing a pill is both easier and more instantly gratifying than cutting out sugary drinks. The bottom line is, making dietary changes is hard, especially when there are purported quick-fixes in the form of medication. This doesn’t change the fact that you still can’t have your cake and eat it too—you can't get healthy while maintaining an unhealthy lifestyle. This is particularly pertinent for individuals who are at risk for or already have type 2 diabetes. Wouldn’t it be great if there was concrete evidence to demonstrate how much more worthwhile making behavioral changes is?

The National Institutes of Health and the National Institute of Diabetes and Digestive and Kidney Diseases initiated a clinical research study assessing the effectiveness of diabetes prevention using either medication or of weight loss through lifestyle changes in pre-diabetic patients. The 3,234 participants in the study were drawn from centers across the US and nearly half of the participants (45%) were members of minority populations - African American, Alaska Native, American Indian, Asian American, Hispanic/ Latino, or Pacific Islander - who are known to have an increased risk of developing diabetes.

The study participants were organized into three groups. The first received expert coaching to modify eating patterns and physical activity in order to lose 7% of body weight. The second group was given an 850mg dose of metformin twice a day. Members of the third group served as controls and were given placebos and information on lifestyle changes.  

The study results demonstrated that both the drug as well as diet and activity coaching reduced the risk of developing diabetes. However, participants in the lifestyle coaching group were 58% less likely to develop diabetes compared to the control group. Those in the metformin group were only 31% less likely to develop diabetes than the control. Lifestyle changes were nearly twice as effective as medication. 

What’s particularly notable is that the data indicated that merely informing patients of the changes they need to make isn’t equivalent to professional coaching. The control group was provided with resources illustrating what healthful eating is and suggesting tips for losing weight. Yet, this information was only effective when coupled with what the study authors referred to as “intensive training in diet, physical activity, and behavior modification.” Without individualized coaching, the instructive materials were meaningless.

This only underscores the essential role of dietitians regarding diabetes treatment. Long term behavioral changes are the most effective form of prevention. Behavioral changes are unlikely to be made alone though, which is why dietitians and nutritionists should never lose sight of their value! As research of this type becomes more prolific, the more aware the public will become of the value of nutritional counseling. In the meantime, we'll continue making a difference, one patient at a time.

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