Univ. Malaya Medical Centre
Combining lifestyle interventions and drugs is the ideal strategy to prevent
diabetes in people with impaired glucose tolerance(IGT).
Lifestyle interventions include physical activity and dietary changes, such as
decreasing daily fat intake. However, if patients are unable to achieve weight
loss or maintain an intensive program, then doctors should use
pharmacological agents.
The Diabetes Prevention Program(DPP), a large 3-year study of people with
IGT examined the efficacy of three interventions: intensive lifestyle
modification, standard lifestyle recommendations with metformin, and
standard lifestyle recommendations with placebo(NEJM 2002;346:393~403).
Patients in the intensive lifestyle modification group, who were monitored
frequently, were able to lose up to about 7 percent of their initial body weight
by 24 weeks. The incidence of diabetes was reduced by almost 60% in this
arm.
Finnish diabetes prevention study(DPS) also showed a similar decrease in the
progression to diabetes with lifestyle modification(Br J Nutr
2000;83:S137~142). A large preliminary study in Da Qing, China in 1992
looked at various versions of exercise and diet(Diabetes Care
1997;20:537~544) for the same purpose, with significant reduction of
progression to diabetes with intensive lifestyle modification. In the metformin
arm of DPP, progression to diabetes was reduced by 31 percent. Metformin
decreases insulin resistance, which prevails in people with IGT.
The head-to-head comparison between metformin and intensive lifestyle
modifications found the latter to be more effective. However, although lifestyle
interventions are the most economically viable, they are not easy to put into
practice because they require very frequent, intensive intervention with
trainers and dieticians to maintain the motivation of keeping in line with the
protocol.
Pharmacological agents such as metformin can be used as an alternative
therapeutic measure especially in people who may not be able to undertake
intensive lifestyle modification, such as those with other medical co-
morbidities, including heart disease or joint disorders, eg, osteoarthritis.
While the use of metformin is not limited to any specific age group,
contraindications such as renal impairment and diseases that predispose to
hypotension should be ruled out before it can be prescribed.
■ 기사 요지
말레이시아 말라야대의료원의 찬 시우 펑 박사의 `내당능이상(IGT) 환자의 당뇨병 예방`에 관
한 본지 자매지 메디칼트리뷴 아시아판에 소개된 글이다.
내당능이상 환자의 당뇨병 발생 연구로 예방에 가장 이상적인 방법으로 생활습관 개선요법과
약물치료 병용을 권고하고 있다. DPP 연구에서는 집중적 생활습관개선요법군과 표준생활습
관개선요법+metformin군의 당뇨병 발생률이 각각 60%, 31% 감소했다.
집중적 생활습관개선요법이 제일 큰 효과를 나타냈지만, 운동요법이 불가능한 환자까지 고려
하면, 두 요법의 병용이 가장 이상적이라는 설명이다. 정리·이상돈 기자
sdlee@kimsonline.co.kr