MedWire News: Two-year results from a community intervention designed to reduce the incidence of Type 2 diabetes show marked reductions in rates of insulin resistance and glucose metabolism disorders, especially among those with highest participation.
“Prevalence of Type 2 diabetes mellitus appears to be increasing unabated, particularly so amongst indigenous people who have been exposed to relatively rapid acculturation,” say Kirsten Coppell (University of Otago, Dunedin, New Zealand) and team.
The Ngati and Healthy project is an ongoing community intervention set up in a rural, largely Maori population in New Zealand north of Gisborne. The intervention was designed to reduce diabetes risk by encouraging weight loss in the overweight and obese, increased physical activity, increased intake of whole grain cereal, vegetables, and fruit, and reduced intake of energy dense foods with high fat and sugar content.
In this study, the researchers report results from the initial baseline (n=286) and 2-year (n=235) surveys from the project. The surveys involved an oral glucose tolerance test, measurement of fasting insulin and lipids, measurement of anthropometric characteristics, and collection of dietary and demographic data.
Writing in the journal Diabetes Research and Clinical Practice, the researchers report that overall insulin resistance had declined significantly from 35.5% at baseline to 25.4% at 2 years. Prevalence of Type 2 diabetes also decreased from 12.6% to 10.6% across the whole group.
This was largely due to the dramatic reduction in insulin resistance from 38.2% to 25.6% in women aged 25–49 years. Reductions in insulin resistance among women aged 50 years and older, men aged 25–49 years, and men aged 50 years and older were also present, but non-significant.
In women aged 25–49 years, the proportion of individuals meeting the minimum recommended exercise level and consuming wholemeal or wholegrain bread in preference to white bread increased significantly by 15.20% and 23.20%, respectively, over the 2 years.
In comparison, older women did not significantly increase their consumption of wholemeal bread (1.98% increase), but 16.03% more met the minimum recommended exercise level in 2006 than in 2003.
Neither older nor younger men had significant changes in exercise level, but consumption of wholemeal bread did increase by 20.37% in the younger group and 10.27% in the older group of men over the study period.
The largest reductions in weight, body mass index, and triglycerides were also seen in the group of younger women, although they were not statistically significant.
“Our demonstration of a significant decrease in insulin resistance prevalence and associated changes in lifestyle in a group who most actively participated in the healthy lifestyle intervention suggests that it is possible to stem the tide of the diabetes epidemic in an indigenous population in the long term,” conclude Coppell et al.
“Challenges for the future include the requirement of sustaining the momentum in the long term, to further engage men of all ages and to enhance the structural component of the strategy.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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