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When we find that a patient is pre-diabetic or insulin resistant or even diabetic once most of our patients don’t want to go on medications i understand that i didn’t want to either my family used to call me doctor three days i won’t go into the digression and the story on that but basically it was i didn’t like to take medications i didn’t like to give medications
So one of the one of the there are ways to deal with insulin resistance one of them is lifestyle which it has many components to it and another is metformin so this question often comes up which is better lifestyle or a metformin and actually there has been some world-class research done in that area so i’ll get to that in just a minute but before i do a brief
Introduction ford brewer f ord bre wer preb met heart attack stroke cancer disability dementia prevention started off as an er doc and went on to hopkins to get some training and prevention and ended up running the program there so come see us if you have some interest in living 20 more good years now i mentioned there’s some world-class research about metformin
Versus lifestyle and yes you can’t get any more if you see some a piece of research medical research published in the new england journal of medicine you can rest assured that’s usually some pretty good science and it’s usually of world-class impact this is reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin so they did that study
They took 3234 non diabetic patients but these were folks that had insulin resistance or pre-diabetes metformin metabolic syndrome and they did one of two two branches it was randomized clinical trial they followed him up for two point eight years now in the group that had nothing done actually there are three groups i’m sorry the first group had nothing done and two
Experimental groups the second experimental group had metformin alone and the third group had lifestyle intervention so here’s the way it went 11 per 100 person years incidents of type 2 diabetes if you did nothing seven point eight cases of diabetes if you just took metformin and didn’t do anything else four point eight new cases four hundred person years that’s a
Hundred people times a year of experience if you did lifestyle so that is a resounding clear statement that lifestyle does truck metformin now well good question what was lifestyle intervention was it just reading a book or giving them a book or having them watch a video no they had loss of 7% body weight goal at least a hundred and fifty minutes of exercise each
Week and now this didn’t have this wasn’t done into a 2002 so it didn’t have some of the high-intensity interval training and resistance training that’s now been shown to be even more effective than what they used and you can do fewer minutes with it too they did basically walking and low in intensity aerobics but again had to get two-and-a-half hours every week
They had sixteen lessons in a curriculum with one-on-one coaching oh a 2026 week duration and that involved diet exercise and behavior modification things that a lot of patients don’t like to get into so yes no question lifestyle does trump just metformin alone there’s nothing that can there’s no medication made that can have a positive impact like a thirty pound
Weight loss if you need to have that today we’ve got a lot more information regarding diet and that diet is getting the carbs out of our diet especially these baked white flour carbs and even more so fructose in a liquid form format like obviously obesity in a cup sodas coca-cola and pepsi cola in addition believe it or not orange juice is fructose in a liquid
Format so you also need to avoid that what about the exercise now we’re seeing that and the american college of sports medicine has proven this studied this seven-minute high-intensity workout now they’ve studied and they’ve shown it is effective so again the oh in the old days even 5-10 years ago we used to think that you just had to do hour after hour after hour
In the in the gym no you don’t you have but you do have to do some intensity i don’t think you you can’t do five or six seven minute workouts and you’re fine you need to have at least three workouts with significant intensity for a week high-intensity interval training and you do need to have a couple of other workouts walking is great the other thing that’s been
Shown to improve insulin resistance is resistance training now most of the time people think especially men when we say resistance training they’re thinking upper extremity getting big arms big guns weight training well yeah you can do that but actually what we really want to focus on is leg thigh hip strengthen you can do that with something like a foot called
A foot up split squad glute bridges lunges any of those things large muscles lower body your hips and your thighs have far more muscle mass than your upper body and those hips and thighs and that large muscle mass actually pulls sugar out of the blood that’s why it helps with insulin resistance and metabolic syndrome and for the intense intervals it’s been shown
That that increased insulin of like effect where the muscles are pulling sugar out of the blood actually goes up for about 48 hours no one do you need to do at least three episodes per week you do three intense episodes per week and your muscles are in a state for most of the week where they’re pulling sugar out of your blood so it’s like an end endogenous insulin
Helper something else we’ve discovered since that study was done and published in the new england journal no2 we’re just beginning to get a huge amount of science coming in regarding the value of sleep in diabetes prevention management of insulin resistance and metabolic syndrome and decrease in heart attack and stroke risk and alzheimer’s risk thank you for your attention
Transcribed from video
Metformin vs Lifestyle? Which is better? FORD BREWER MD MPH By Ford Brewer MD MPH
