Diabetes Prevention Program DPP

The Diabetes Prevention Program (DPP) is the most effective evidence-based intervention program for people with prediabetes to reduce the risk of type 2 diabetes. For people with abnormal glucose tolerance, standard DPP intervention for one year can reduce the risk of diabetes by 58%, and the protective effect is even better than taking metformin alone.

Last month I met a 52-year-old Uncle Zhang at a community free clinic. His fasting blood sugar was 6.8mmol/L, and his OGTT (oral glucose tolerance test) 2-hour value was 10.2mmol/L, just on the line of pre-diabetes. I suggested that he join the DPP intervention group in the community, but he was quite dismissive and said, “Isn’t it just about eating less and moving more? I can adjust it myself at home, so I don’t have to check in with you.” As a result, he came for a self-examination three months later. His blood sugar did not move at all, his mouth was not controlled at all, and he exercised for three days and fished for two days. Finally, he joined the group obediently. In just two months, the glucose tolerance test returned to the normal range.

Many people have the same misunderstanding about DPP as Uncle Zhang did at the beginning. They think it is just a slogan-style health education. To be honest, the original DPP, which was first launched in the United States in 2002, has very strict standards: you must accumulate 150 minutes of moderate-intensity exercise every week, lose at least 7% of your body weight within one year, and have strict grams of carbohydrate, fat, and protein intake requirements every day. At that time, scholars in the field of public health advocated standardized implementation, believing that only unified standards could ensure results. However, doctors on the front line of the clinic were the first to object: ordinary people could not adhere to such strict requirements.

Our center conducted a local DPP follow-up survey in the past two years. For the group that strictly followed the original American standard, the half-year retention rate was only 23%. Most people either found it too troublesome to count grams for meals, or could not spare a fixed time for exercise, so they quit midway. Instead, we relaxed the standards for the experimental group: they exercised for 30 minutes cumulatively on at least three days a week, and were considered qualified as long as they could lose 3% of their body weight. They even allowed one "relaxation day" per week without strict diet control. The half-year retention rate jumped to 61%, and the final reduction in the risk of diabetes was 47%. The effect was not much different from that of the strict group, but it covered more than twice as many people.

When I led the DPP team myself, I would never ask people to give up milk tea or late-night snacks. It was too anti-human. If you like to drink milk tea, first switch from full sugar to three-quarter sugar, and change the iced tea to room temperature. Drink one less cup a week and gradually reduce the amount. ； If you don’t have time to go to the gym, you can get off the bus two stops before get off work and walk home, or go downstairs with your children to play for 20 minutes after dinner. This can also be counted as exercise time. ； The aunties in the community love square dancing, so I just count them as moderate-intensity exercise, and I don’t have to force them to do fast walking or jogging – after all, the core of DPP is to let you develop habits that last a lifetime, not to do a few months of surprise training.

There is actually quite a quarrel among academic circles over the scope of application of DPP. One group of people believes that DPP should strictly limit the group of people who are in the early stage of sugar administration and should not expand the scope of application at will. Otherwise, it will easily lead to over-medical treatment. People who are just a little fat and have normal blood sugar will be labeled as "high-risk for diabetes", which will easily lead to psychological burden. However, another school of chronic disease prevention scholars believe that as long as high-risk groups have a family history of diabetes, have a BMI over 28, or are sedentary and eat unhealthy diets, even if their blood sugar is temporarily normal, they can still perform a light version of DPP intervention to nip the risk in the bud. A small sample test conducted by our center last year also showed that for this type of high-risk group with early intervention, the incidence of prediabetes within 3 years is 32% lower than that without intervention, and the effect is still very obvious.

Nowadays, there are various DPPs available to everyone. The DPP intervention prescribed by the endocrinology department of the hospital will be equipped with specialized nutritionists and doctors, and indicators such as insulin resistance and glycated hemoglobin will be measured regularly. If your insulin resistance is particularly severe and you really can’t control it, the doctor will also recommend a small dose of metformin. This is also clearly recognized by the guidelines. It does not mean that DPP can only rely on lifestyle adjustments. Community DPPs are generally of a public welfare nature, mainly for collective check-in and regular health classes. They are very cost-effective and are sufficient for early-stage candidates for ordinary sugar. As for the many "DPP fat loss camps" and "sugar control camps" on the Internet, everyone should keep their eyes peeled. If they ask you to buy a bunch of meal replacements and health products right from the start without asking about your medical history and blood sugar conditions, then they are basically charging IQ tax. Don't believe it.

Last week, Uncle Zhang came to the clinic specifically to see me, carrying half a bag of tomatoes grown at home. He said that now he walks downstairs for half an hour after eating every day. His cigarettes have also been reduced from one pack a day to three. Last week, his glycosylated hemoglobin was measured at 5.4%, which is better than the indicators of many young people. He said that he originally thought that he would have to take medicine for the rest of his life when he got diabetes, but he didn't expect that he could prevent the disease just by changing some small habits in his life. In fact, DPP has never been a high-end, cutting-edge medical solution. To put it bluntly, it is a professional person who will help you get your deviant living habits back on track little by little. There is no need to pursue any perfect standards. The solution that is most suitable for you is the one that you can stick to.