people who are at high risk for type 2 diabetes and take metformin have lower rates of CVD and cancer, as has been suggested by smaller studies. In 2010, the US Congress authorized the Centers for Disease Control and


Prevention (CDC) to establish the National Diabetes Prevention Program (National DPP). This was a public-private partnership initiative to offer the program in communities across the United States to prevent type 2 diabetes. Practitioners who would like to offer the National DPP must go through a special training and meet the CDC Diabetes Prevention Recognition Program standards and operating procedures. The National DPP also requires that evaluation data be submitted to the CDC every 6 months. Data required include participant demo- graphics, weights, and physical-activity minutes. RDNs are uniquely qualified to become National DPP lifestyle coaches; in this role, they lead lifestyle change pro- gram sessions and support and encourage participants. More information on the National DPP is available on the CDC website (www . cdc . gov / diabetes / prevention).


The Finnish Diabetes Prevention Study


At about the same time that the DPP was underway in the United States, the Finnish Diabetes Prevention Study16


was taking place across the Atlantic Ocean. The aim


of the study was to investigate the association of change in body weight and waist circumference and diabetes incidence with dietary macronutrient composition and energy density. The study randomly assigned 522 men and women†


with impaired


glucose tolerance to either standard care (control) or intensive diet and exercise counseling (lifestyle intervention). This study did not have a medication group. Interestingly, the findings of the Finnish study mirrored the findings of the DPP: namely, that an intensive lifestyle intervention was highly effective in preventing the onset of type 2 diabetes. The lifestyle intervention in the Finnish study involved making the following five recommended lifestyle changes with the help of counseling16


:


ƒ losing more than 5% of initial body weight ƒ reducing fat intake to less than 30% of total energy intake ƒ reducing saturated fat intake to less than 10% of total energy intake ƒ increasing fiber intake to more than 15 g per 1,000 kcal ƒ exercising more than 4 hours per week


Participants were given a success score based on how many of the five recom- mended lifestyle changes they were able to achieve, earning one point for each goal successfully met. So, participants who were unable to make any of the changes had a score of zero; those who achieved one of the changes had a score of 1; and so on, up to a score of 5. Figure 10.3 illustrates the success scores of study participants in both the control and intervention groups.16


The results demonstrate that the


higher the adherence to the five lifestyle changes (the higher the success score), the greater the chance of avoiding the onset of diabetes (ie, the lower the incidence of diabetes). Participants in the lifestyle group who successfully made four or five of the recommended changes with the help of intensive counseling had an almost zero incidence of type 2 diabetes. It is worth noting that those participants in the control group who made lifestyle changes were also successful in reducing their incidence of diabetes but not as effectively as those in the lifestyle intervention group. This may indicate that support from health care professionals with expertise


† Study participants were described as men and women. Gender was not further specified.


174 SECTION 3: Interventions for the Treatment of Overweight and Obesity


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