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Meager data on benefits of diet and exercise for type 2s

As I search the daily news buzz on type 2 diabetes, it is drugs, drugs and more drugs. Where is the research buzz on diet and exercise to help treat type 2? I just went camping with a friend who lost 60 pounds and threw away his insulin. My eyes first widened in amazement at this feat, then gleamed in utter respect as I witnessed his celebration of newfound health as we hiked, ate nutritious food and threw frisbees with our kids. While losing weight and exercising is certainly not the magic cure for all type 2s (there are thin type 2s!), the power of diet and exercise is undeniable in improving blood sugar control and lessening drug doses.

Cochrane Library reviewers recently examined a wide body of research on diet and exercise for diabetics. The search yielded 36 articles across 18 different trials, including 1,467 participants with type 2 diabetes. The quality of the data was poor, only a minority of the trials included hard clinical endpoints such as macrovascular/microvascular complications, quality of life or even death. Weight and blood glucose control were central to most of the articles, factors easier to measure. Meta-analyses could not even be performed for various forms of dietary advice (e.g., very low calorie vs. low-calorie or dietary advice plus behavior changes) due to scant data. On a brighter note, seven studies comparing dietary advice vs. dietary advice with exercise suggested participants adding exercise realized a significant decrease in glycated hemoglobin of 0.9%. Researchers call for well-designed studies examining a range of interventions. They noted a promising study called "look AHEAD" is measuring the long-term health effects of weight loss in men and women, ages 45 to 75, who are overweight and have type 2 diabetes. Funded by the National Institutes of Health, "look AHEAD" participants will be assessed up to 11 and a half years.

We need an influx of clinical studies examining the effects of dietary and exercise improvements on the health of people with type 2. We need Big Diet and Exercise to step in, instead of the ubiquitous presence of Big Pharma ... a Big D&E with research and development money to help inform and motivate people to change their lifestyles. Yes, we are a car country. Yes, genetically-modified, processed, carbo-loaded food is the norm for most. Yes, kids don't run around and play like they used to, the computer and rigidly organized sports have usurped free play. Yes, parents are usually working and families have less time around the dinner table. Yes, there are other issues beyond these. Childhood and adult obesity is a multi-pronged problem, and we need research and solutions across many levels. What motivates people to better their health? Is there some saturation point when frustration and sadness over worsening health triggers behavioral change? It is easy to scold, to point a finger and say "just lose 50 pounds." Yet shame is abusive and wrong, let alone ineffective. A healthy diet and regular exercise takes desire, fortitude and a culturally supportive environment.

I see the glass more than half full. Plenty quit smoking, and in many societal segments it is not cool to smoke anymore. There currently is no nicotine patch for bolstering better diets and more exercise, but people can and do adopt healthier habits, and the food industry and societal norms will ultimately reflect the masses.

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