Inpatient TX helps obese diabetics alter lifestyle

Obese type 2 diabetes patients with metabolic syndrome saw dramatic improvements in cardiac function and multiple cardiovascular risk factors after only 3 weeks in a German pilot study of an intensive lifestyle modification program including aerobic exercise and a low glycemic and insulinemic diet.

The catch? Those first 3 weeks of lifestyle modification were conducted on an inpatient basis. That’s essential to the program’s success because it enables patients to see early impressive benefits, resulting in improved long-term adherence, as reported at the annual congress of the European Society of Cardiology.

She presented the results of an innovative prospective study involving 25 patients with type 2 diabetes and metabolic syndrome. Their baseline mean body mass index was 37kg/m2, with 41 percent body fat. They averaged 52 years of age and had a 4-year history of diabetes. None had known coronary disease, and 19 were on oral antidiabetic medications.

The inpatient intervention included 2 hours of supervised moderate intensity aerobic exercise daily and a low glycemic and insulinemic (LOGI) diet developed by the director of the obesity program at Children’s Hospital Boston, and a pediatric endocrinologist at Harvard Medical School, Boston.

This low-carbohydrate diet derives 30 percent of calories from protein, 45 percent from fat, and only 25 percent from carbohydrate. It’s a diet designed to reduce postprandial blood glucose peaks and compensatory hyperinsulinemia while lowering blood pressure and improving lipid abnormalities as explained by Academic Hospital and State Clinic, Munich.

The LOGI diet was adopted for the program because of mounting evidence that traditional “heart healthy” low-fat diets are of questionable effectiveness. An article was cited at Albert Einstein College of Medicine in New York that has been influential in Germany. The authors argue that US national dietary guidelines introduced in the late 1970s that advocated low-fat diets for public health reasons were based on weak scientific evidence, and may have had the unintended consequence of contributing to obesity by leading to overconsumption of carbohydrates.

It was reported that after 3 weeks of inpatient lifestyle modification, patients showed mean reduction of 2.6kg in body weight, 3.7 cm in waist circumference, 54 percent in postmeal insulin, and 6mm Hg and 5mm Hg in systolic and diastolic blood pressure, respectively. Other significant reductions occurred in BMI and myocardial oxygen consumption, as well as in glycosylated hemoglobin, postprandial glucose, C-reactive protein, fasting glucose, and triglyceride levels. Exercise capacity improved. Echocardiographic evidence of diastolic dysfunction, detected in 18 patients initially, was present in only 8 patients after 3 weeks.

Particularly impressive was the fact that all these benefits were achieved despite a sharp reduction in the need for antidiabetic medications. Of 19 patients initially on antidiabetic drugs, 13 were no longer taking them after 3 weeks, and the 6 who remained on medication were taking markedly reduced doses.

Audience members raised two main criticisms. One is that these results, while impressive, are short term. The other is that a 3-week inpatient hospitalization for intensive lifestyle modification would not be feasible in North America.

Earlier studies have shown that most patients continue on the program with good maintenance of benefits after they return home.

As for the hefty cost of a 3-week inpatient program, German care health payers are open to the idea of aggressively attacking major chronic degenerative diseases in the early stages to reduce far greater downstream costs.