“Although lifelong intervention is recommended as a cornerstone of diabetes management, this recommendation is not always followed in older adults due to beliefs that it is too late to change lifelong habits and that dieting could be harmful for this population,” explains Dennis T. Villareal, MD. “As a result, many older adults with diabetes are treated with drugs and exposed to side effects without first exploring the full benefit of an intensive lifestyle intervention (ILI) program.”
For a study published in Diabetes Care, Dr. Villareal and colleagues sought to establish whether lifestyle intervention would improve glycemic control and age-relevant outcomes in older adults with diabetes and comorbidities. A cohort of 100 older adults with diabetes were randomly assigned to 1-year ILI or healthy lifestyle (HL) group. The ILI consisted of a diet and exercise program beginning at a facility and moving into community fitness centers and homes. Change in A1C was the primary outcome, while secondary outcomes included changes in physical function, body composition, glucose regulation, and QOL.
Improvements Observed Across the Board in the ILI Cohort
The study team observed a substantial decrease in body weight in the ILI group (-8.4 ± 0.6 kg) but not the HL group (-0.3 ± 0.6 kg; Figure), and the ILI group experienced a greater decrease in visceral fat and body weight compared with the HL group. Additionally, A1C improvement was greater in the ILI cohort than the HL cohort and correlated with improved insulin sensitivity and disposition indices.
Greater improvements on Physical Performance Test scores were seen in the ILI compared with the HL group, as well as VO2peak. Gait, strength, and 36-item Short Form Survey (SF-36) Physical Component Summary score also improved more in the ILI group. Finally, total insulin dose was reduced in the ILI group by 19.8 ± 4.4 units per day.
Never Too Late to Start Lifestyle Intervention
“For older adults with diabetes, it’s never too late to start lifestyle intervention,” Dr. Villareal says. “Clinicians should consider implementing lifestyle intervention as a primary therapy for this patient population, which could complement medical therapy for diabetes and improve QOL.”
The study authors acknowledge some limitations of the study relating to the exclusion criteria. “The participants were physically able to participate in a lifestyle program and thus may not be fully representative of the general population of older adults with diabetes,” they wrote. “Our study was limited to 1 year’s duration, so additional studies are needed to determine longer-term adherence and whether the beneficial effects of lifestyle intervention therapy can reduce diabetes complications and associated medical costs or prevent the institutionalization of older adults with diabetes.”
Older Adults Very Motivated to Change Lifelong Habits
For future research, Dr. Villareal and colleagues would like to see the lifestyle intervention protocol in this study evaluated for widespread implementation in a practical setting. For example, he would like to see older adults with diabetes be able to take advantage of Medicare Part B coverage for medical nutrition therapy and other Medicare plans for coverage of participation in fitness centers among older adults.
Older people are especially vulnerable to diabetes, Dr. Villareal points out. “As people age, they need fewer calories, but many continue to eat the same way they did when they were younger, which results in weight gain,” he says, adding that older people tend to exercise less, which is another risk factor for T2D. “However, we found that older adults with diabetes are very motivated to change lifelong habits. They had excellent compliance with the intervention, showed significant weight loss, and improved their A1C.”
