A Practical Lifestyle Intervention for Patients with Prediabetes and Polyneuropathy
Abstract Number: 900-P
Authors: SHELDON B. SMITH, A. GORDON SMITH, JAMES RUSSELL, AMANDA PELTIER, EVA L. FELDMAN, JONATHAN GOLDSTEIN, J. ROBINSON SINGLETON
Institutions: UT; MI; New Haven, CT
Results: The Diabetes Prevention Program (DPP) demonstrated that intensive diet and exercise counseling by trained personnel significant reduces the risk of progression of impaired glucose tolerance (prediabetes) to diabetes and is superior to metformin. The intervention is labor intensive and difficult to implement in a routine clinical setting. A more easily employed intervention based on the DPP has been developed as part of a prospective study of patients with prediabetes and polyneuropathy. A nutritionist provides individualized counseling at baseline and once every three months, while exercise counseling is provided by a research coordinator. Subjects are asked to engage in 150 minutes of moderate exercise weekly, reduce fat calories to less than 25% of total daily intake, and to lose 7% of body weight. Metabolic parameters, neuropathy severity, and cutaneous microvascular reactivity measured using laser Doppler flowmetry are followed. To date 30 subjects have completed at least one year of study. There has been an average 5% decline in weight and 15% decline in total cholesterol (p< .05). Those who lost 5% or more of body weight had an improvement in LDL and 2 hour glucose following a 75 gram oral dextrose load (p< .05). Cutaneous microvascular reactivity to iontophoresed acetylcholine improved 57% (p< .005). While clinical and electrophysiologic measures of neuropathy severity did not change, there was a trend towards improved sweat function. These results suggest an easily implemented diet and exercise counseling program results in improved metabolic parameters in patients with prediabetes. Improved microvascular and sweat function suggest this program may be effective in mitigating microvascular endpoints such as polyneuropathy.