Diet and exercise counseling does not reduce cardiovascular or all-cause mortality associated with prediabetes and type 2 diabetes

Question clinique

Does intensive diet and exercise counseling affect mortality in patients with prediabetes or type 2 diabetes?


In relatively young older people (if there is such a category), intensive lifestyle counseling regarding diet and physical activity produced no significant benefit on all-cause or cardiovascular mortality over an average 4.25 years of follow-up. There might be a benefit seen over longer periods, though the longest studies in this meta-analysis found no benefit over 16 to 21 years of follow-up. 1a

Plan de l'etude: Meta-analysis (randomized controlled trials)

Financement: Foundation

Cadre: Various (meta-analysis)


Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA

Discutez de ce POEM



Questionable usefulness of conclusions

Not clear from the synopsis what the ‘usual care’ consisted of (typically would include some lifestyle advice, so how much more intensive was the intervention?); also unclear whether or not the intervention was associated with behavioural change (& therefore whether desired behavioural change would have had a beneficial effect, I.e. was counselling ineffective in eliciting behavioural change or was behavioural change ineffective in altering outcome). Mortality as sole outcome measure in a relatively young group over (on average) a short period also seems to be a limitation, as baseline mortality would presumably be low; inclusion of other outcomes would seem a more realistic indicator of effectiveness of a lifestyle intervention in a group that is still in middle age (on average).


Diet and Exercise counselling in DM2

May have been more relevant to look at actual life style changes rather than counselling. Every one knows most people don't listen to what we say.


Diet and exercise counselling in DM2

I agree with the Feb.6/23 Anonymous comments above. Evidence has shown that tighter diabetic control slows the development of complications of DM2.

Charles Edward Morton

diet and exercise

If one believes, as I do, that T2DM is the end stage of a metabolic disease that starts with Insulin resistance decades earlier then it is discouraging but not surprising that late interventions that produce minimal change in BMI will change Mortality,
Standard American "food" and inactivity start the process of insulin resistance in childhood. By The 4th decade the majority have this disease .


health care self

word is still out on this

David Fraser Smith

prediabetic advice

It's one thing to offer advice, but taking that advice by patients can be a very frustrating exercise at times, as I recall from my days of family practice. Pediatrics has been more satisfying in this regard,


Impact assessment

Very good



Offrir un counseling est une bonne chose, mais il aurait été plus pertinent d'évaluer la mortalité chez les individus qui utilisent ce counseling pour modifier réellement leurs habitudes de vie.