The Finnish Diabetes Prevention Study assessed the extent to which lifestyle changes and risk reduction remain after discontinuation of active counselling.
The following is a summary of the findings.

Overweight, middle-aged men (n=172) and women (n=350) with impaired glucose tolerance were randomly assigned to intensive lifestyle intervention or control group. After a median of 4 years of active intervention period, participants who were still free of diabetes were further followed up for a median of 3 years, with median total follow-up of 7 years. Diabetes incidence, bodyweight, physical activity, and dietary intakes of fat, saturated fat, and fibre were measured.

Results: During the total follow-up (median 7 years), the incidence of type 2 diabetes was 4.3 per 100 person-years in the intervention group and 7.4 in the control group, indicating 43% reduction in relative risk.
The risk reduction was related to the success in achieving the intervention goals of weight loss, reduced intake of total and saturated fat and increased intake of dietary fibre, and increased physical activity.
Beneficial lifestyle changes achieved by participants in the intervention group were maintained after the discontinuation of the intervention, and the corresponding incidence rates during the post-intervention follow-up were 4.6 and 7.2, indicating 36% reduction in relative risk.

Excercise
Adults should take at least 30 minutes of moderate exercise five days a week.
Moderate exercise is classified as brisk walking, playing golf, badminton, tennis (doubles), cycling, housework.

For people who need to manage their weight and are at risk of putting on weight and becoming obese, 45 to 60 minutes a day.

For people who have been obese, or are still obese and have lost weight, 60-90 minutes a day.

Cardiovascular Disease and Diabetes
Diabetes more than doubles the risk of cardiovascular disease. In the United Kingdom, 35% of deaths are due to cardiovascular causes, compared with about 60% in those with type 2 diabetes and 67% of type 1 diabetic patients over 40 years old. Diabetes increases the risk more in women than men, so that the risk of cardiovascular death is equal in both sexes in diabetic patients.
The presence of proteinuria and even microalbuminuria increases the risk of coronary heart disease and mortality from myocardial infarction.

The United Kingdom prospective diabetes study (UKPDS) was published in 1998 and compared tight with less tight blood pressure control (mean 144/82 mm Hg v 154/87 mm Hg). Heart failure was reduced by 56%, strokes by 44%, and combined myocardial infarction, sudden death, stroke, and peripheral vascular disease by 34% (myocardial infarction alone was reduced non-significantly by 16%). Tight control also had considerable benefits on the development of retinopathy and proteinuria.

Heart outcomes prevention evaluation (HOPE) and microHOPE study
This study over 4.5 years comprised 9297 patients and included 3577 diabetic patients (98% with type 2 diabetes). Patients with diabetes and one other risk factor for cardiovascular disease were randomly treated with the angiotensin converting enzyme inhibitor ramipril 10 mg daily or placebo. Systolic blood pressure decreased by 2-3 mm Hg and reduced combined myocardial infarction, strokes, and deaths from cardiovascular diseases by 25%. The relative risk of myocardial infarction was reduced by 22%, the relative risk of stroke by 33%, and relative risk of cardiovascular death by 37%.
The cardiovascular benefit was greater than that attributable to the decrease in blood pressure. This treatment represents a vasculoprotective and renoprotective effect for people with diabetes.

It was concluded that angiotensin converting enzyme inhibitors were the first line treatment for blood pressure control in diabetes.

Blood Pressure Recommendations

Blood pressure >160/100 mm Hg should always be treated in those with and without diabetes aiming for a level of <140/80mm Hg (audit standard<140/90 mm Hg).
The target blood pressure is <140/80 mm Hg unless the patient has microalbuminuria or macroalbuminuria, when the aim is for 130/80 mm Hg.

Blood pressure of 140-159/90-99 mm Hg should be treated in all diabetic patients and aggressively in those with cardiovascular risk factors, especially if there is evidence of end organ damage; aim for <140/80 mm Hg.

Blood pressure <140/80 mm Hg should be treated if there is evidence of target organ damage or if the 10 year CHD risk exceeds 15%. The aim is for <140/80 mm Hg.

Blood pressure of >130/80 mm Hg should be treated in patients with microalbuminuria or macroalbuminuria.

Blood pressure should be checked annually or more frequently as indicated.
Other factors may also help reduce blood pressure eg
Salt restriction
Weight reduction or exercise programmes
Reduction of excessive alcohol intake

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