The massive, long-term Diabetes Prevention Program study has now found (twice!) that altering one’s lifestyle in terms of diet and exercise is more effective than a common prescription drug in delaying the onset of the disease. To power this study and its recently published follow-up, dozens of medical centers conducted multiple examinations each year on thousands of patients – 3234 in the first 3-year study, and 2665 in the 10-year follow. It’s impressive – and more clinically useful – to look at the summary data accumulated from this very large population of patients. But what kind of impact does a huge study such as the DPP have on the individual participants?
With help from Margaret Matulik, the DPP program coordinator at the University of Chicago Medical Center, I connected with a couple of the study subjects to hear about the lives behind the data points. Both Katherine Seaberry, 80, and Robert Nolan, 61, are from Chicago, and enrolled in the study in the late 1990’s. Both were also motivated to join the DPP due to their respective families’ experience with diabetes – Nolan’s sister and mother suffered from the disease and died around the age of 60, and Seaberry said her “whole family” has been diagnosed with diabetes.
“It saved me,” Seaberry said of her involvement with the Diabetes Prevention Program. “It’s amazing that I’m the only one in my family that’s not diabetic. If I wasn’t in this study, I think I would be diabetic by now.”
Seaberry, who first heard about the study on the news, was placed in the “lifestyle intervention” group, where subjects were given instruction and assistance from health professionals in improving their diet and exercise with the goal of reducing total weight by 7 percent. Looking back, Seaberry said she recalls how valuable that education and encouragement was to her health – she proudly says now that the only pill she takes is her daily vitamin, her morning eggs and bacon has been replaced by a bowl of oatmeal, and she walks five miles almost every day.
“I didn’t even didn’t know what a fat gram was, I would just eat,” Seaberry said. “It’s a beautiful life once you learn. So many people now are diabetic because of their lifestyle, what they’re eating and drinking. They say ‘you’re so silly to get up and walk,’ but I enjoy it. I’ll walk as long as I’m on the Earth, even though I’m 80 years old. I’m old, but I don’t feel that way.”
Nolan enrolled in the study with his brother, and was placed in the group receiving the anti-diabetes drug metformin. Though he was ultimately diagnosed with diabetes (under new, reduced guidelines for the diagnosis) two years ago, he has remained off of insulin and feels that the study delayed and dampened his disease. Not all of the lifestyle interventions have stuck – “the habits you get into are tougher to change,” Nolan said – but when he compares his health to his sister and mother’s issues before their early deaths, he said he felt like “something’s happened right.”
Nolan also wondered if the experience of him and others in the study could ultimately factor into the current national debate about the cost of health care.
“I think people are concerned about diabetes and one of the things that has to be looked at is what are we doing about it,” Nolan said. “My sister and mother both had extensive medical treatment at the end of their lives because of diabetes. Maybe one way to keep health care costs down is to educate people with these kinds of studies.”
In fact, one (impossible to implement) form of treatment that might lead people to healthier lifestyles and diabetes prevention would be to enroll everyone at risk into studies. Matulik said roughly a third of the original participants based at UChicago continue to keep their weight at the target level as much as 13 years after enrollment, while another third fluctuate between the target and higher weights. That’s an impressive figure, likely down to the quarterly health classes, check-ups and weigh-ins each subject undergoes – not to mention the firm encouragement of coordinators such as Matulik, who says she is known by the intimidating moniker of the “Margerator.”
Matulik said that Seaberry was a perfect example of the positive effect of simple lifestyle changes once they are assimilated into a person’s life.
“Everyone says know what supposed to do, they just don’t do it,” Matulik said. “For those that do it, who lost the 7 percent and kept it off, they are so routine now we don’t really have to do a whole lot with them – they walk no matter what, in the rain, snow, or cold.”