Finnish Diabetes Prevention Study Research Articles

High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish Diabetes Prevention Study

The aim of this study was to investigate the association of dietary macronutrient composition and energy density with the change in body weight and waist circumference and diabetes incidence in the Finnish Diabetes Prevention Study. Overweight, middle-aged men (n=172) and women (n=350) with impaired glucose tolerance were randomised to receive either 'standard care' (control) or intensive dietary and exercise counselling. Baseline and annual examinations included assessment of dietary intake with 3-day food records and diabetes status by repeated 75-g OGTTs. For these analyses the treatment groups were combined and only subjects with follow-up data (n=500) were included. Individuals with low fat (<median) and high fibre (>median) intakes lost more weight compared with those consuming a high-fat (>median), low-fibre (<median) diet (3.1 vs 0.7 kg after 3 years). In separate models, hazard ratios for diabetes incidence during a mean follow-up of 4.1 years were (highest compared with lowest quartile) 0.38 (95% CI 0.19-0.77) for fibre intake, 2.14 (95% CI 1.16-3.92) for fat intake, and 1.73 (95% CI 0.89-3.38) for saturated-fat intake, after adjustment for sex, intervention assignment, weight and weight change, physical activity, baseline 2-h plasma glucose and intake of the nutrient being investigated. Compared with the low-fat/high-fibre category, hazard ratios were 1.98 (95% CI 0.98-4.02), 2.68 (95% CI 1.40-5.10), and 1.89 (95% CI 1.09-3.30) for low-fat/low-fibre, high-fat/high-fibre, and high-fat/low-fibre, respectively. Dietary fat and fibre intake are significant predictors of sustained weight reduction and progression to type 2 diabetes in high-risk subjects, even after adjustment for other risk factors.

Serum Uric Acid as a Harbinger of Metabolic Outcome in Subjects With Impaired Glucose Tolerance

Serum uric acid is the major product of purine metabolism (1). In cross-sectional studies, uric acid correlates with components of the metabolic syndrome: hypertension, obesity, low HDL cholesterol, hypertriglyceridemia, hyperinsulinemia, and insulin resistance (2–4). Although determination of uric acid is widely available and inexpensive, it has been overlooked as a marker of disturbed glucose metabolism. We studied its role in predicting changes in glucose tolerance and insulin levels and in the development of type 2 diabetes in the Finnish Diabetes Prevention Study. The design of the Finnish Diabetes Prevention Study has been previously described in detail (5). Briefly, 40- to 65-year-old overweight or obese individuals with impaired glucose tolerance were eligible. Impaired glucose tolerance was defined as a 2-h plasma glucose at 7.8–11.0 mmol/l after oral glucose (75 g) with a fasting glucose <7.8 mmol/l (6). The protocol was approved by the ethics committee of the National Public Health Institute (Helsinki, Finland). All participants gave written informed consent. In all, 522 individuals from five study centers were randomly assigned to the intervention ( n = 265) or control ( n = 257) groups. Serum uric acid concentrations were measured at baseline and at least once during the follow-up in 475 of the 522 participants, and these 475 are included in the present study. The original trial ended after an average follow-up of 3.2 years. In this study, follow-up …

Lifestyle intervention to prevent diabetes: intensive AND cost effective

Type 2 diabetes is a major cause of morbidity and mortality, and despite treatment advances appears to be increasing in incidence. Since individuals at risk for the disease are usually identifiable in the prediabetic phase of impaired glucose tolerance, early intervention might prevent diabetes and hence its complications from developing. Obesity and sedentary living are powerful determinants of diabetes, and thus lifestyle change is a logical approach to prevention of this disease. Recent clinical trials have now tested the effectiveness of this intervention and form the basis for this review. Three clinical trials have demonstrated that, compared with usual care, lifestyle intervention significantly reduced progression rates to diabetes in prediabetic individuals. Each trial incorporated individualization and repeated long-term contacts with facilitators, in which dietary and physical activity goal setting and behavior modification were central themes. Progression to diabetes was reduced in the Da Qing study by approximately 40%, in the Finnish Diabetes Prevention Study by 58% and in the Diabetes Prevention Program by 58%. The Diabetes Prevention Program included a cost-benefit unit that estimated the per capita costs of the lifestyle intervention to exceed that of the usual care group by Dollars 3540, which translated to a cost of Dollars 15,700 per case of diabetes prevented. Lifetime cost-utility analysis demonstrated an overall cost of Dollars 1100 per quality-adjusted life year. These findings make the case for translation of research findings to healthcare systems. Although there is more to be learned about effective strategies in clinical practice, it seems clear that the intervention needs to incorporate individualization and long-term interaction with trained facilitators.

Even After It Ends, a Lifestyle Intervention Prevents Diabetes

Lifestyle interventions can prevent or postpone the onset of type 2 diabetes in people at risk, but do these effects persist after the intervention is discontinued? In the Finnish Diabetes Prevention Study, 522 overweight, middle-aged patients with impaired glucose tolerance were randomized to enter an intensive, individualized …

Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance

Aim To evaluate the effectiveness of lifestyle interventions in people with impaired glucose tolerance (IGT). Methods Participants with IGT ( n = 78), diagnosed on two consecutive oral glucose tolerance tests (OGTTs), were randomly assigned to a 2-year lifestyle intervention or to a control group. Main outcome measures were changes from baseline in: nutrient intake; physical activity; anthropometry, glucose tolerance and insulin sensitivity. Measurements were repeated at 6, 12 and 24 months follow-up. Results After 24 months follow-up, there was a significant fall in total fat consumption (difference in change between groups (Δ intervention − Δ control) = −17.9, 95% confidence interval (CI) −33.6 to −2.1 g/day) as a result of the intervention. Body mass was significantly lower in the intervention group compared with controls after 6 months (−1.6, 95% CI −2.9 to −0.4 kg) and 24 months (−3.3, 95% CI −5.7 to −0.89 kg). Whole body insulin sensitivity, assessed by the short insulin tolerance test (ITT), improved after 12 months in the intervention group (0.52, 95% CI 0.15–0.89%/min). Conclusions These findings complement the findings of the Finnish Diabetes Prevention Study and the American Diabetes Prevention Study, both of which tested intensive interventions, by showing that pragmatic lifestyle interventions result in improvements in obesity and whole body insulin sensitivity in individuals with IGT, without change in other cardiovascular risk factors.

Improved fibrinolysis by an intensive lifestyle intervention in subjects with impaired glucose tolerance. The Finnish Diabetes Prevention Study

The aim of this study was to investigate the effects of lifestyle intervention on the levels of plasminogen activator inhibitor (PAI-1) and fibrinogen in subjects participating in the Finnish Diabetes Prevention Study (DPS). In five DPS centres, 321 subjects with impaired glucose tolerance (intervention group, n=163; control group, n=158) had their PAI-1 and fibrinogen levels measured at baseline and at the 1-year follow-up. Additional 3-year follow-up assessments were carried out in a sample of 97 subjects in one of the DPS centres (Turku). The intervention programme included an intensive lifestyle intervention aiming at weight reduction, healthy diet and increased physical activity. During the first intervention year, PAI-1 decreased by 31% in the intervention group but showed no change in the control group (p<0.0001). In the Turku subgroup, the decrease in PAI-1 persisted throughout the 3-year follow-up. Changes in PAI-1 were associated with the number of lifestyle changes made during the first year (p=0.008). Weight reduction was the most important factor explaining the decrease in PAI-1. Changes in fibrinogen levels did not differ between the groups. In addition to the previously reported reduction in the risk of type 2 diabetes in DPS participants with impaired glucose tolerance, the intensive dietary and exercise intervention had beneficial long-term effects on fibrinolysis as indicated by the reduced levels of PAI-1. These results suggest that elevated PAI-1 levels in obese subjects with impaired glucose tolerance are mostly reversible by lifestyle changes, especially those geared to weight reduction.

Highlights from the Literature

Highlights from the Literature

Genetic variation in leptin receptor gene is associated with type 2 diabetes and body weight: The Finnish Diabetes Prevention Study

Genetic variation in leptin receptor (LEPR) gene has been reported to associate with insulin and glucose metabolism and adiposity in different study settings and various populations. We wanted to evaluate the association between LEPR polymorphisms, diabetes risk and body weight in Finnish subjects with impaired glucose tolerance (IGT). We investigated the associations of the three LEPR polymorphisms (Lys109Arg, Gln223Arg, 3'UTR Del/Ins) with the conversion to type 2 diabetes and the changes in body weight in 507 individuals with IGT participating in the Finnish Diabetes Prevention Study. Participants were randomized to either an intensive diet and exercise intervention group or a control group. After 3 years, the odds ratio for the development of type 2 diabetes in individuals in the control group with the Lys109Lys genotype was 2.38-fold higher than in individuals with other genotype combinations (P=0.016). Irrespective of group individuals with the Gln223Gln genotype had higher conversion to type 2 diabetes (OR 2.01 (95% CI 1.03-3.93)) than the Arg223 allele carriers (P=0.042). The risk was more pronounced in the control group than in the intervention group. Individuals having the 3'UTR Del/Del genotype had a slightly higher body weight throughout the study than those with the insertion allele (P=0.020), although no difference in weight change was observed. Two polymorphisms (Lys109Arg, Gln223Arg) in the extracellular domain of the leptin receptor predicted the conversion to type 2 diabetes in high-risk individuals with IGT. The Del/Ins polymorphism in the 3'UTR of LEPR was associated with body weight.

Polymorphisms in the SLC2A2 (GLUT2) Gene Are Associated With the Conversion From Impaired Glucose Tolerance to Type 2 Diabetes

Impaired insulin secretion is a fundamental defect in type 2 diabetes. The aim of this study was to investigate whether single nucleotide polymorphisms (SNPs) in the genes regulating insulin secretion (SLC2A2 [encoding GLUT2], GCK, TCF1 [encoding HNF-1alpha], HNF4A, GIP, and GLP1R) are associated with the conversion from impaired glucose tolerance (IGT) to type 2 diabetes in participants of the Finnish Diabetes Prevention Study. With the exception of SLC2A2, other genes were not associated with the risk of type 2 diabetes. All four SNPs of SLC2A2 predicted the conversion to diabetes, and rs5393 (AA genotype) increased the risk of type 2 diabetes in the entire study population by threefold (odds ratio 3.04, 95% CI 1.34-6.88, P = 0.008). The risk for type 2 diabetes in the AA genotype carriers was increased in the control group (5.56 [1.78-17.39], P = 0.003) but not in the intervention group. We conclude that the SNPs of SLC2A2 predict the conversion to diabetes in obese subjects with IGT.

Strategies for the prevention of type 2 diabetes and cardiovascular disease

The DECODE (Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe) study provides a clear overview of the outcomes of metabolic syndrome and type 2 diabetes in terms of cardiovascular mortality in a European population. The study demonstrates that the presence of the metabolic syndrome doubles the risk of cardiovascular mortality, with a stronger effect in women than in men.1 Although each individual component of the metabolic syndrome confers an increased risk of cardiovascular mortality, this is not as pronounced as when the metabolic syndrome itself is present. The more the components of the metabolic syndrome, the higher cardiovascular mortality.1 In addition, DECODE also demonstrates that the combination of metabolic syndrome and type 2 diabetes leads to a significantly increased risk of cardiovascular or all-cause mortality, with this risk again being higher in women ( Table 1 ). Life expectancy for people with type 2 diabetes is decreased by 5–10 years and adults with diabetes have an annual mortality of about 5.4%, which is double the rate for non-diabetic adults.2,3 View this table: Table 1 Relative risk for mortality in subjects with either metabolic syndrome, or diabetes, or both1 The often devastating impact of these conditions has led to much interest in how outcomes for people with type 2 diabetes can be improved and how type 2 diabetes can be prevented in the first place. ### Lifestyle interventions A number of studies have now demonstrated the efficacy of specific, goal-oriented lifestyle interventions in the prevention of type 2 diabetes. This is clearly demonstrated by the Finnish Diabetes Prevention Study (DPS),4 in which 522 middle-aged, overweight subjects with impaired glucose tolerance (IGT)5 were randomly assigned to either the intervention group or the control group. Each subject in the intervention group received individualized counselling6 aimed at reducing weight and intake of total and …

Prevention of Type 2 Diabetes

Changes in the human environment and in human behavior and lifestyle, in conjunction with genetic susceptibility, have resulted in a dramatic increase in the incidence and prevalence of diabetes in the world. The rapid escalation of the number of people with type 2 diabetes (T2DM) and diabetes-related cardiovascular disease demands urgent action on prevention. The Finnish Diabetes Prevention Study and The Diabetes Prevention Program showed that the prevention (or delaying) of T2DM is feasible and effective. Both of these trials led to a reduction of 58% in the conversion to diabetes in subjects with impaired glucose tolerance. Compared to lifestyle changes, drug treatment in the prevention of diabetes in people at high risk for T2DM has been less beneficial. Metformin (31%) or acarbose (25%) treatment obtained only about a half of the reduction in the conversion to diabetes compared to lifestyle changes. These drugs require monitoring, and have significant side-effects. Also the effect of orlistat (37%) did not reach the effect of lifestyle modification. Results of the Troglitazone in Prevention of Diabetes study are suggestive for the prevention, but the trial was too small, and included only one ethnic group (Hispanic) and one gender (women). On the basis of the evidence available, we do not have a definite proof that T2DM is prevented in any of these trials. However, we can safely conclude that the current evidence strongly favors the notion that lifestyle changes are the primary means to tackle the epidemic of T2DM.

Lifestyle Intervention, Glucose Tolerance, and Risk of Developing Type 2 Diabetes Mellitus

Diabetes mellitus is rapidly becoming one of the main health issues in the 21st century. Environmental factors such as lifestyle habits (i.e., physical inactivity and dietary intake) and obesity may act as initiating factors or progression factors for type 2 diabetes. Therefore, changes in lifestyle (i.e., diet and physical activity) should have the potential to postpone or prevent the development of type 2 diabetes mellitus in subjects at high risk (for example, those with impaired glucose tolerance [IGT]). Several independent and well-controlled randomized studies have shown the beneficial impact of a lifestyle intervention program on glucose tolerance, insulin resistance, and diabetes risk in populations at risk for developing type 2 diabetes mellitus. After 2 years of a combined diet and physical activity intervention program, according to general public health guidelines, the Study on Lifestyle-intervention and IGT Maastricht (SLIM) revealed an improved glucose tolerance in the intervention group compared to a further deterioration in the control group. The Finnish Diabetes Prevention Study (DPS) and the US Diabetes Prevention Program (DPP) both observed a 58% reduction in diabetes risk after 3 years of intervention in a high-risk population. Although other intervention strategies can reduce the incidence of diabetes, lifestyle changes are the most effective mean of delaying or preventing the development of type 2 diabetes mellitus. For a successful implementation of a diabetes prevention program in a primary healthcare setting, both patients and healthcare professionals should be aware of the (clinical) significance of impaired glucose tolerance and the effectiveness of lifestyle interventions to prevent or postpone type 2 diabetes mellitus and its complications.

Lifestyle strategies for weight control: experience from the Finnish Diabetes Prevention Study

Currently, in many European countries more than half the adult population is overweight; it hass become 'abnormal' to be of 'normal weight'. The risk of type 2 diabetes, CVD, hypertension and certain forms of cancer increase with increasing weight. Biological evolution has produced body-fat-regulating mechanisms that are more powerful in protecting against weight loss than against weight gain. The current environment offers constant availability of affordable palatable energy-rich foods, with no need to consume the energy through physical activity. The 'obesogenic' environment is to some extent a political issue, but it has been shown that the healthcare system can also have a role in preventing obesity-related morbidity. The Finnish Diabetes Prevention Study was the first controlled randomised study to show that individualised lifestyle counselling of individuals with high risk of developing type 2 diabetes can influence diet, physical activity and body weight, and that type 2 diabetes can be prevented, or at least postponed. Most importantly, lifestyle changes do not have to be extreme. If the population would adopt a lifestyle in line with the official nutrition recommendations, the obesity and diabetes trend could at least be stabilised.

Physical Activity in the Prevention of Type 2 Diabetes

Clinical trials have demonstrated that lifestyle changes can prevent type 2 diabetes, but the importance of leisure-time physical activity (LTPA) is still unclear. We carried out post hoc analyses on the role of LTPA in preventing type 2 diabetes in 487 men and women with impaired glucose tolerance who had completed 12-month LTPA questionnaires. The subjects were participants in the Finnish Diabetes Prevention Study, a randomized controlled trial of lifestyle changes including diet, weight loss, and LTPA. There were 107 new cases of diabetes during the 4.1-year follow-up period. Individuals who increased moderate-to-vigorous LTPA or strenuous, structured LTPA the most were 63-65% less likely to develop diabetes. Adjustment for changes in diet and body weight during the study attenuated the association somewhat (upper versus lower third: moderate-to-vigorous LTPA, relative risk 0.51, 95% CI 0.26-0.97; strenuous, structured LTPA, 0.63, 0.35-1.13). Low-intensity and lifestyle LTPA and walking also conferred benefits, consistent with the finding that the change in total LTPA (upper versus lower third: 0.34, 0.19-0.62) was the most strongly associated with incident diabetes. Thus increasing physical activity may substantially reduce the incidence of type 2 diabetes in high-risk individuals.

Role of skeletal muscle‐fibre type in regulation of glucose metabolism in middle‐aged subjects with impaired glucose tolerance during a long‐term exercise and dietary intervention

The aim of this study was to investigate the role of skeletal muscle fibre type in the regulation of glucose metabolism in middle-aged obese subjects with impaired glucose tolerance (IGT) during a 2-year exercise and dietary intervention. Muscle biopsies (musculus vastus lateralis) were taken from 22 subjects belonging to the intervention group of the Finnish Diabetes Prevention Study [1]. According to their myosin heavy chain (MHC) profile at the baseline, the subjects were divided into two groups: IGT(slow) (n=10) with a high proportion of MHC I isoforms and IGT(fast) (n=12) with a high proportion of MHC II isoforms in the vastus lateralis muscle. The intervention consisted of dietary counselling, strength and power training and/or aerobic exercise. The amount of exercise was the same in both groups; the exercise frequency was 5.1+/-2.7 h/week in the IGT(slow) and 5.1+/-2.8 h/week in the IGT(fast) group. Fasting glucose (p<0.05), 2-h glucose (p<0.05), fasting insulin (p<0.05), haemoglobin A1c (HbA(1c)) (p<0.01) and insulin resistance (p<0.05) [homeostasis model assessment for insulin resistance (HOMA-IR)] decreased in the IGT(fast) group, whereas only the 2-h glucose and HbA(1c) concentrations decreased in the IGT(slow) group. The amount of the glycogen synthase kinase-3-alphabeta (GSK-3-alphabeta) decreased in the IGT(fast) group (p<0.05). Exercise training increased the lactate dehydrogenase (LDH) (p<0.01), LDH-1 (p<0.05) and citrate synthase (CS) (p<0.05) activities in the vastus lateralis muscle in the IGT(slow) group, but only the CS activity (p<0.05) in the IGT(fast) group. The glucose metabolism improved both in the IGT(slow) and IGT(fast) group during the 2-year exercise and dietary intervention. The change was more prominent in the IGT(fast) group than in the IGT(slow) group, associated with the decrease of the GSK-alphabeta protein expression in skeletal muscle. The exercise training improved both glycolytic and oxidative capacity in the vastus lateralis muscle. The glycolytic capacity improved in the IGT(slow) group and the oxidative capacity in both groups.

Polymorphisms of the SUR1 (ABCC8) and Kir6.2 (KCNJ11) Genes Predict the Conversion from Impaired Glucose Tolerance to Type 2 Diabetes. The Finnish Diabetes Prevention Study

Type 2 diabetes is caused by defective insulin secretion and impaired insulin action. We investigated whether common polymorphisms in the SUR1 and Kir6.2 genes are associated with increased risk of type 2 diabetes in 490 subjects with impaired glucose tolerance participating in the Finnish Diabetes Prevention Study. The 1273AGA allele of the SUR1 gene was associated with a 2-fold risk of type 2 diabetes [odds ratio (OR), 2.00; 95% confidence interval (CI), 1.19-3.36; P = 0.009]. This silent polymorphism was in linkage disequilibrium with three promoter polymorphisms (G-2886A, G-1561A, and A-1273G), and they formed a high-risk haplotype having a 2-fold risk of type 2 diabetes (OR, 1.89; 95% CI, 1.09-3.27; P = 0.023). Subjects with both the high-risk haplotype of the SUR1 gene and the 23K allele of the Kir6.2 gene had a 6-fold risk for the conversion to diabetes compared with those without any of these risk genotypes (OR, 5.68; 95% CI, 1.75-18.32; P = 0.004). We conclude that the polymorphisms of the SUR1 gene predicted the conversion from impaired glucose tolerance to type 2 diabetes and that the effect of these polymorphisms on diabetes risk was additive with the E23K polymorphism of the Kir6.2 gene.

Nutritional fats and the risk of type 2 diabetes and cancer

Dietary factors are important predictors for the risk of diabetes type 2. Increased consumption of fibre-rich foods, fruits and vegetables as well as limited amounts of total and saturated fats are essential elements in the prevention of diabetes type 2. The association between these dietary factors and the appearance of diabetes was not only present in cohort studies but were also major elements in the dietary part of the two large diabetes prevention trials (Finnish Diabetes Prevention Study, Diabetes Prevention Program). There is also strong evidence for a relation between obesity and total fat intake and the incidence of certain types of cancers. There is a significant correlation between total fat intake and the risk of cancer; however, it is much weaker than that of the effect of red meat. Recommendations to decrease red meat intake, particularly processed meat, may decrease the risk of colorectal and prostate cancer and may have beneficial effects on breast cancer as well, although this evidence is less compelling. Overall, recommendations focused on controlling or reducing body weight by regular physical activity and avoidance of excessive energy intake from all sources, particularly from fat and saturated fats, by increasing consumption of fibre-rich carbohydrates, vegetables and fruits are effective in decreasing the risk for type 2 diabetes by more than 50% in high-risk individuals. Similar dietary patterns are likely to diminish the manifestation of certain forms of cancers. These conclusions are in agreement with current recommendations for cancer prevention as propagated by the American Cancer Society.

Prevalence of the metabolic syndrome and its components: findings from a Finnish general population sample and the Diabetes Prevention Study cohort.

To assess the prevalence of the metabolic syndrome (MetS) in two independent Finnish study cohorts. The prevalence of the MetS by modified World Health Organization criteria was analyzed in different categories of glucose tolerance in a cross-sectional, population-based sample of 2,049 individuals (FINRISK) aged 45-64 years and in 522 participants of the Finnish Diabetes Prevention Study (DPS) with impaired glucose tolerance (IGT). In the FINRISK cohort, the MetS was present in 38.8% of the men and 22.2% of the women. The prevalence was 14.4 and 10.1% in subjects with normal glucose tolerance, 74.0 and 52.2% in subjects with impaired fasting glucose, 84.8 and 65.4% in subjects with IGT, and 91.5 and 82.7% in subjects with type 2 diabetes in men and women, respectively. Among women, the prevalence of the MetS increased with increasing age. In the DPS cohort, the MetS was present in 78.4% of the men and 72.2% of the women with IGT. The MetS was extremely common in middle-aged subjects The high prevalence in men was mostly due to their high waist-to-hip ratio. The prevalence of the MetS increased in both sexes with deterioration in glucose regulation. Approximately 75% of the subjects with IGT had the MetS. Because the syndrome includes the major risk factors for atherosclerotic vascular diseases and is the major antecedent for type 2 diabetes, concerted preventive action should be targeted to control all the features of the MetS.

SCREENING FOR DIABETES IN GENERAL PRACTICE

SCREENING FOR DIABETES IN GENERAL PRACTICE

Exercise: A Key Component of Diabetes Management

Exercise has long been recognized as an essential component of diabetes management. Elliot Joslin once referred to exercise as “the second steed in the diabetic's three-horse chariot,” sharing equal billing with diet and insulin.1 Subsequent generations of diabetes practitioners have established exercise as one of the four cornerstones of care (along with diet, medication, and monitoring) and have come to learn a great deal more about the mechanisms by which exercise is able to provide such profound benefits for physical health. Atherosclerotic vascular disease remains the number one killer of people with diabetes, and research has shown exercise to be of tremendous utility in its treatment. It is known that exercise ameliorates many of the known vascular disease risk factors, favorably influencing levels of blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, and glycemia.2 More recent research suggests that exercise may exert similarly favorable effects on emerging vascular disease risk factors as well, including thrombosis, endothelial function, and levels of C-reactive protein.2,3 Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise appears to aid in the loss of visceral fat, quite literally getting to the core of the metabolic syndrome. Results of the Diabetes Prevention Program4 demonstrated that as little as 150 minutes per week of moderate exercise as part of a lifestyle intervention significantly decreased the progression of type 2 diabetes in patients with preexisting impaired glucose tolerance. These findings were comparable to those of the Finnish Diabetes Prevention Study.5 The magic bullet–like ability of exercise to counter much of the metabolic disruption and ensuing pathology occurring in diabetes is beyond remarkable and has understandably led to greater emphasis being placed on the physiological benefits of exercise. Lesser known, and far less celebrated, …