Intensive lifestyle intervention may successfully help older adults with diabetes improve glycemic control, suggests a recent study published in the journal Diabetes Care.¹

Lifestyle modification is an essential component of management of patients with diabetes and its beneficial impact on disease control has been well-established. It is therefore recommended as a first-line treatment for diabetes although compliance is quite frequently inadequate among older adults and often is not prescribed considering the age of the patient. In this randomized-controlled trial, Celli et al sought to investigate if lifestyle intervention would also help older adults with diabetes and underlying comorbid conditions in improving glycemic control and age-relevant outcomes.

For this, 100 older adults with diabetes were randomized to intensive lifestyle intervention (ILI) or healthy lifestyle (HL) for one year. The ILI consisted of an initially supervised diet and exercise program, which then continued at community-fitness centers and homes. Change in HbA1c was the primary outcome of the study, while changes in physical function, body composition, glucose regulation and quality of life were selected as the secondary outcomes.

Improvement in HbA1c among the older adults in the ILI group was substantial (-0.8%) compared to those assigned to healthy lifestyle (0.1%). Correspondingly, the improvement in insulin sensitivity and disposition indices were also greater in the ILI group vs healthy lifestyle group; 1.2 ± 0.2 vs -0.4 ± 0.2 and 26.0 ± 8.9 vs -13.0 ± 8.4 109 min-1, respectively.

Participants in the ILI group had a significant decrease in body weight (-8.4 kg) in comparison to those in the healthy lifestyle group (-0.3 kg). Reduction in visceral fat was also more in the ILI group (-261 cm3) than in the healthy lifestyle group (-30 cm3). The daily insulin dose was reduced by nearly 20 units in the ILI group.

Physical Performance Test scores and VO2 peak also improved more among those assigned to ILI; 2.9 vs -0.1 and 2.2 vs -1.2 mL/kg/min, respectively. Similarly, greater improvement in gait, strength, and 36-item Short Form Survey (SF-36) Physical Component Summary score was also noted in the ILI group vs healthy lifestyle group. Mild hypoglycemic episodes were noted in the ILI group.

This study demonstrates improved glycemic control in older adults with diabetes with ILI along with significant weight loss and reductions in visceral fat and total insulin dose.

Lifestyle intervention should also be recommended for this patient group complementary to medical treatment for diabetes. And it could even reduce the required dose of antidiabetic medication/s. Older adults with diabetes therefore should be counselled and encouraged to lead a healthy lifestyle and be active as much as possible as per their functional status, for greater cardiometabolic risk reduction.

Reference

1. Celli A, et al. Lifestyle intervention strategy to treat diabetes in older adults: a randomized controlled trial. Diabetes Care. 2022 Jul 26;dc220338. doi: 10.2337/dc22-0338.