Lifestyle Intervention for Prediabetes Treatment in the Elderly

Using prediabetes definitions, the Diabetes Prevention Program (DPP) trial showed that lifestyle intervention could delay or prevent diabetes for those persons experiencing prediabetes. While the primary outcome of the trial was diabetes and not a reduction of cardiovascular risk, cardiovascular risk factors such as high blood pressure and high cholesterol were monitored.  However, a recent study did shed light on the effect of lifestyle intervention on cardiovascular risk for older persons.

Indeed, one of the primary goals of the study was to determine if reversion to normal glucose from prediabetes could reduce cardiovascular risk in older people. The study was done by investigators in Germany. The investigators used results from the KORA S4 study which was a population-based health survey. The age range of the participants in the study was 55 to 74 years of age.

To determine prediabetes, the investigators used the following definitions of prediabetes: For HbA1c, they used a range of 5.7 to 6.4 percent. For oral glucose tolerance tests, the investigators used a range of 140 to 199 mg/dl. The investigators found that by lowering the weight and waist circumference, an older person could increase his or her “probabilities of returning to” normal blood glucose and maintaining normal blood glucose.

The investigators concluded that “in older adults, even moderate weight reduction contributes to reversion from prediabetes to normoglycaemia and to maintaining normoglycaemia." This conclusion supports the results from the original DPP trial. In fact, the results from the trial indicated that lifestyle intervention is, in general, more effective in prediabetes treatment for persons over 60 years of age than for younger persons.

Healthcare providers should consider these results and use the results in consultations with older patients who are diagnosed with prediabetes. The efforts could be beneficial to the patients, and the effort might even improve an organization’s financial position by giving the healthcare organization a strong platform for negotiating contracts with insurers.

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The Mediterranean Diet May Slow the Progression of Chronic Kidney Disease

It is estimated that chronic kidney disease (CKD) is experienced by 15% of the US adult population. The disease is serious and can lead to kidney failure and death. And approximately 90% of those who have CKD don’t even know they have the disease. It has been suggested by some that diet and exercise can be important elements in CKD treatment.

Estimated glomerular filtration rate or eGFR is a frequently used measurement in diagnosing CKD. Lower than normal eGFR measurements often indicate some reduction in kidney function. And one study has shown that the Mediterranean diet and increased physical activity can be effective in slowing the decline of eGFR and, thus, kidney function degradation.

Researchers in the study looked at 6719 overweight or obese subjects. The subjects ranged in age from 55 to 75 years of age. And each subject had metabolic syndrome, which is defined by a set of conditions, happening together, that can increase a person’s risk of heart disease, stroke and type 2 diabetes. The set of conditions typically include “increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.”

The subjects in the above-mentioned study were randomly assigned to one of two groups. Some subjects were randomized to the group receiving an intensive weight loss intervention consisting of a Mediterranean diet and increase physical activity. And the other subjects were randomized to a group receiving normal care. The primary outcome was the change in eGFR after one year. The study was called the “PREvencion con Dieta MEDiterrianea-PLUS” or PREDIMED-PLUS trial.

At one year, there was a 40% lower degradation in eGFR for the intervention group compared to the group receiving usual care. These results showed that diet and exercise are important in CKD treatment. The researchers concluded that “the PREDIMED-Plus lifestyle intervention approach may preserve renal function and delaying CKD progression and overweight/obese adults.”

So, healthcare providers should consider counseling patients on the benefits of diet and exercise in the treatment of CKD. The providers should give specific advice on the kind of diets and exercise that are conducive to slowing the progression of CKD.

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