Researchers at the King Saud University and King Saud bin Abdulaziz University for Health Sciences conducted a three-armed RCT to determine the effects of different treatments in lowering the incidence of full-blown metabolic syndrome in pre-diabetics.
They recruited 294 pre-diabetics aged 25 to 60 and assigned them into three groups: one received general advice on lifestyle change, another was put through an intensive lifestyle modification programme, and the last was given general advice and metformin.
Those in the second group had to have individual consultations with a dietician to assess food intake, as well as with a vitamin D expert to learn about the health benefits of optimal levels. The latter suggested a half hour of sunlight exposure twice a week, either before 10 AM and / or after 3 PM.
The participants in the second group also received exercise guidelines, and were advised to record at least 5,000 daily steps on a pedometer they were issued.
The researchers screened for full metabolic syndrome and its components at baseline, then at six and 12 months.
They then observed that in the group that had undergone the lifestyle modification programme, full metabolic syndrome had been reduced by 26%, while the group that had received general advice and metformin had seen a 22.4% decrease.
Both groups also saw a significant reduction of the number of metabolic syndrome components, with the lifestyle modification group having a "clinically significant" decrease in metabolic syndrome components.
The group that had been given general advice, on the other hand, saw an 8.2% reduction in metabolic syndrome.
The researchers wrote: "This study highlights the clinical potency of (an) intense lifestyle modification programme versus other diabetes prevention options in reducing metabolic syndrome in Saudi adults with elevated fasting glucose."
Limitations and manifestations
They also said one of the study's limitations was that its participants all had impaired glucose tolerance, which meant the results may not apply to those with normal glucose regulation but who had full-blown metabolic syndrome.
The study also left out details on the actual lifestyle changes its subjects made in terms of diet- or exercise-related variables.
The researchers added that though the participants had to self-monitor, the significant reversal in metabolic syndrome among those on the intensive lifestyle modification programme implied that proper guidance could indeed help people make positive lifestyle changes.
Additionally, they had employed a "unique statistical approach" to assessing metabolic syndrome and its components by examining the change in the total number of metabolic syndrome components as an outcome variable.
They concluded: "Intensive lifestyle modifications or low-dose metformin for a period of 12 months significantly reduces metabolic syndrome manifestation in individuals with pre-diabetes, with lifestyle modifications being superior to metformin, as the latter's potency is limited to weight loss and reduction of hyperglycaemia, while the former improves all the components of metabolic syndrome, together as well as independently."
"Effects of Different Dietary and Lifestyle Modification Therapies on Metabolic Syndrome in Prediabetic Arab Patients: A 12-Month Longitudinal Study"
Authors: Hanan A. Alfawaz, et al.