ABSTRACT
BACKGROUND: Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus, but no large trials have compared interventions. We investigated the effects of diet and physical activity on blood pressure and glucose concentrations. METHODS: We did a randomised, controlled trial in southwest England in adults aged 30-80 years in whom type 2 diabetes had been diagnosed 5-8 months previously. Participants were assigned usual care (initial dietary consultation and follow-up every 6 months; control group), an intensive diet intervention (dietary consultation every 3 months with monthly nurse support), or the latter plus a pedometer-based activity programme, in a 2:5:5 ratio. The primary endpoint was improvement in glycated haemoglobin A(1c)(HbA(1c)) concentration and blood pressure at 6 months. Analysis was done by intention to treat. This study is registered, number ISRCTN92162869. FINDINGS: Of 593 eligible individuals, 99 were assigned usual care, 248 the diet regimen, and 246 diet plus activity. Outcome data were available for 587 (99%) and 579 (98%) participants at 6 and 12 months, respectively. At 6 months, glycaemic control had worsened in the control group (mean baseline HbA(1c) percentage 6·72, SD 1·02, and at 6 months 6·86, 1·02) but improved in the diet group (baseline-adjusted difference in percentage of HbA(1c) -0·28%, 95% CI -0·46 to -0·10; p=0·005) and diet plus activity group (-0·33%, -0·51 to -0·14; p<0·001). These differences persisted to 12 months, despite less use of diabetes drugs. Improvements were also seen in bodyweight and insulin resistance between the intervention and control groups. Blood pressure was similar in all groups. INTERPRETATION: An intensive diet intervention soon after diagnosis can improve glycaemic control. The addition of an activity intervention conferred no additional benefit. FUNDING: Diabetes UK and the UK Department of Health.
Subject(s)
Diabetes Mellitus, Type 2/therapy , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Diabetes Mellitus, Type 2/diet therapy , Exercise Therapy , Female , Health Behavior , Humans , Intention to Treat Analysis , Life Style , Male , Middle Aged , Weight LossABSTRACT
Circular dichroic spectra of A-DNA in 78% ethanol and of tRNA in water and ethanol solutions have been studied at different concentrations of NaCl. An increase in the Na+ concentration from 0.5.10(-4) M to 5.10(-4) M results in a shift of the positive CD band at 264 nm of the A-DNA to a longer wavelength, 272 nm. Simultaneously, the magnitude of the 210 nm band decreases. By contrast in the case of tRNA in water solution an increase in NaCl content results in straight opposite shifts of the CD spectra. This opposite behaviour is shown to the due to a difference in ions effects in water and water-ethanol solutions, since tRNA in the ethanol solution behaves in the same way as A-DNA does in 78% ethanol. We suppose that in aqueous solution in increase in the cation concentration would stabilize the helical conformations with progressively decreasing narrow groove, i. e. more wound. At a high concentration of ethanol (60--80%) the formation of specific complex between the hydrated cations and the double-stranded regions should be taken into consideration. Thus, the hydrated cations may insert into the deep groove exerting the opposite effect of unwinding.
