Report by Liam O'Neill, ACC 2015, San Diego

A unique health coaching programme to promote healthy behaviours which integrates advice on exercise, nutrition as well as stress and sleep can reverse the progression of prediabetes into diabetes, according to a new study being presented at American College of Cardiology’s 64th Annual Scientific Session in San Diego.

The program, which focuses on promoting healthy behaviors and reducing cardiac risk, is unique because unlike others that tend to focus exclusively on exercise and nutrition it also integrates managing sleep and stress, the study authors said.

“Participation in the program seems to help prevent progression to diabetes and improve overall health, said Mariam Kashani, DNP, chief scientific director at Walter Reed National Military Medical Center in Bethesda, Maryland, and the study’s lead author.

Subjects in this study included 508 patients from the Integrative Cardiac Health Project, an ongoing risk management program. Patients received a comprehensive assessment of their cardiovascular health along with personalized health recommendations with tailored goals (all in line with national preventive care guidelines). They then took part in 14 personalized coaching sessions with specialists in nutrition, exercise, sleep and stress management. Researchers examined the impact of the intervention on blood glucose levels and other key risk factors.

Of the 107 participants who had prediabetes—when blood sugar is elevated but not high enough to be diagnosed as type 2 diabetes—at the start of the study, 49 percent were at normal blood glucose levels at the end of the 6-month study period irrespective of weight loss.

"Many more patients reverted to normal blood glucose than expected, especially if we consider that they were not necessarily losing weight," Kashani said, adding that the program is a supplement to usual care. "This is important because prediabetes is a modifiable risk factor for cardiovascular disease."

A major limitation of the study is that it is observational and there is no comparison group. However, Kashani said those who were able to revert to normal blood glucose levels also had significantly lower triglyceride levels at six months compared with others who remained prediabetic. Triglycerides are not only a measure of heart health, but in lifestyle medicine they are also a marker of patient compliance to behavioral change recommendations, according to authors. A study to compare this lifestyle intervention to usual care is underway.

Kashani said the findings confirm that focusing solely on diet and exercise can only get someone so far. "By taking sleep and stress into account, we factor in important hormonal processes to better manage glucose," she said. "When we are stressed, our bodies release extra glucose and when we are tired, we tend to make poor food choices. In this context, people often regain weight, and in doing so, they may revert back to worsening blood glucose levels."