Combo Diet-Exercise Programs Trim Diabetes Risk

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Diet-Exercise Programs, HyperkalemiaTreatment, Metformin for Portal Hypertension

A combination of diet and physical activity programs offered in the community reduce the risk of type 2 diabetes mellitus (DM) in patients who are at increased risk, according to new federal data. A high capacity, oral potassium-binding drug, patiromer, shows promise as a treatment for hyperkalemia. The anti-diabetes medication metformin also may be an effective treatment for portal hypertension.

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Programs Help Patients Revert to Normal Glycemic Levels

• Strong evidence suggests that a combination of diet and physical activity programs can reduce new-onset DM for persons at increased risk for type 2 DM.

• These programs also increase the likelihood of reversion to normal glycemic levels and improve DM and cardiovascular disease risk factors, including weight, blood glucose levels, blood pressure, and lipid levels.

• The US Community Preventive Services Task Force recommends the use of combined diet and physical activity promotion programs to reduce progression to type 2 DM in those at increased risk.

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Combined Program’s Critical Components

• Critical components of a combined diet and physical activity program include trained providers in clinical or community settings who work directly with program participants for at least 3 months; some combination of counseling, coaching, and extended support; and multiple sessions related to diet and physical activity, delivered in person or by other methods.

• Programs also may use 1 or more of the following: diet counselors in various specialties (eg, nutritionists, dietitians, and DM educators); exercise counselors in various specialties (eg, physical educators, physiotherapists, and trainers); physicians, nurses, and trained laypersons; a range of intensity of counseling, with many or few sessions, longer- or shorter-duration sessions, and individual or group sessions; and individually tailored or generic diet or physical activity programs.

• Programs should include specific weight-loss or exercise goals and a period of maintenance sessions after the primary core period of the program.

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US Task Force Conducts Systematic Review

• The task force recommendation is based on evidence from a systematic review of 53 studies that described 66 programs.

• Most programs used a combination of in-person individual and group sessions.

• Almost all programs led to weight loss, reduced risk of DM, or both.

• More intensive programs led to more weight loss and less development of DM.

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Group Programs More Cost-effective

• These diet-exercise programs were cost-effective; group-based programs were the most cost-effective.

• Health care providers usually are the primary resource for patients at increased risk for type 2 DM.

• The task force suggests that health care providers keep informed about local prevention programs offered by community centers or run by insurers or nonprofit or other private contractors.

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New Drug to Treat Hyperkalemia?

• Hyperkalemia, a potentially life-threatening condition, is seen predominantly in patients treated with renin-angiotensin-aldosterone system (RAAS) inhibitors who have stage 3 or greater chronic kidney disease and also may have DM or heart failure.

• Researchers conducted a phase 2, multicenter, open-label, dose-ranging, randomized clinical trial to evaluate patiromer in 306 outpatients with type 2 DM and stage 3 or 4 chronic kidney disease.

• The drug contains a nonabsorbable polymer that binds potassium throughout the GI tract.

• All patients received RAAS inhibitors before and during the study.

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Drug Significantly Reduced Moderate Hyperkalemia

• The patients were randomized to receive 3 starting doses of patiromer depending on whether they had mild or moderate hyperkalemia.

• After 8 weeks, potassium concentrations were reduced significantly from baseline.

• The outcomes were more pronounced in those in the moderate hyperkalemia group.

• The most common treatment-related adverse events were hypomagnesemia and mild-to-moderate constipation. Hypokalemia occurred in 5.6% of participants.

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Metformin Reduces Hepatic Resistance and Portal Pressure

• Metformin appears to reduce hepatic resistance and portal pressure in cirrhotic rats.

• Increased hepatic vascular resistance is the primary factor in the development of portal hypertension.

• Metformin ameliorates vascular cell function in several vascular beds.

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Metformin Plus Propranolol Has Additive Effect

• Researchers evaluated the effects and the underlying mechanisms of metformin on hepatic and systemic hemodynamics in cirrhotic rats, as well as the possible interaction with the effects of propranolol, the current standard treatment for portal hypertension.

• Metformin reduced blood pressure in the liver, liver scarring, and inflammation after 1 week.

• Combining metformin with propranolol further lowered liver blood pressure.

• The researchers concluded that metformin reduces portal pressure by decreasing the structural and functional components of the elevated hepatic resistance of cirrhosis.

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Take-home Messages:

• A federal task force’s systematic review found combined diet and physical activity programs can help prevent or delay the development of DM.

• The drug patiromer could represent an effective new approach to management of hyperkalemia among patients with DM.

• In addition to DM, metformin shows potential as a treatment for portal hypertension.