Mass General's Diabetes Prevention Program made a big difference for one brother facing the very dangerous disease.

Nineteen years ago, type 2 diabetes was looming large for Tim Daly. His identical twin brother, Paul, had just been diagnosed with it. That meant the disease was highly likely to catch up to him in the next five years. But instead, by maintaining a 10 to 14 pound weight loss through the Diabetes Prevention Program (DPP) at Massachusetts General Hospital, Tim has kept diabetes at bay for 17 years.

Tim Daly
Tim Daly

His brother Paul, in the meantime, received diabetes nutrition counseling, but was never able to lose as much weight as Tim. Paul now needs insulin to keep his diabetes under control.

Diabetes is an epidemic in the United States, hand in hand with obesity. “There’s a tidal wave of those at risk,” says David Nathan, MD, director of the MGH Diabetes Center and the Diabetes Clinical Research Center.

Reducing Diabetes Risk

Type 2 diabetes and prediabetes are diagnosed by high levels of glucose—sugar—in the bloodstream. Too much glucose over the years damages nerves and blood vessels and can cause blindness, kidney failure, heart disease and stroke. Prevention and treatment are geared to keeping glucose levels close to normal.

The DPP—a federal multicenter clinical trial planned and overseen by Dr. Nathan—found that a modest 5-10 percent weight loss and moderate physical activity can reduce diabetes risk by more than half. Weight loss and exercise are better than a common diabetes medication called metformin at keeping glucose levels from rising into the harmful range.

Linda Delahanty, MS, RD, LDN, coaches her patients to reach their goals in doable steps.
Linda Delahanty, MS, RD, LDN, coaches her patients to reach their goals in doable steps.

These DPP results, announced in 2002, were astonishing, says Linda Delahanty, MS, RD, LDN, chief dietitian in Mass General’s Diabetes Center and director of Nutrition and Behavioral  Research at the Diabetes Clinical Research Center. “You don’t even have to lose a lot of weight to benefit,” she adds. She’s a central architect of the DPP strategies to help people make sustainable lifestyle changes and has been Tim’s lifestyle coach for the past 17 years.

The DPP study found, too, that even those who don’t lose weight can benefit from exercising more. Those who met the physical activity goal of 150 minutes a week reduced their diabetes risk by 44 percent.

A Simple and Powerful Message

Weight loss and exercise helped so much that the study was stopped one year early so more people could benefit from its message.

Weight loss and exercise helped so much that the study was stopped one year early so more people could benefit from its message.

Another large federal study directed at MGH by Dr. Nathan, called Look AHEAD, assessed the same lifestyle-change approach as in DPP and compared it with usual therapy in those who already have diabetes. Although the researchers did not  find that lifestyle changes reduced risk for cardiovascular events (heart attacks and stroke), those in the lifestyle group had improved blood glucose and blood pressure control and needed fewer drugs to control them, among other health benefits.

Participants in both studies continue to be followed.

How Did Tim Do It?

Tim and the more than 3,000 other patients in the DPP study started at very high risk for diabetes. They were overweight and had prediabetes. Many had family members with type 2 diabetes.

When he enrolled, Tim was age 47, 5’ 10” and weighed 200 pounds. He had never tried to lose weight and though he played basketball weekly, didn’t exercise much. Working with Ms. Delahanty, he hit his target weight of 186 pounds within six months. His glucose levels reverted to normal.

A large trial overseen by David Nathan, MD, found that modest weight loss and moderate physical activity can markedly reduce diabetes risk.
A large trial overseen by David Nathan, MD, found that modest weight loss and moderate physical activity can markedly reduce diabetes risk.

Though he’s gone up and down a few pounds, he has maintained at least a 5 percent weight loss over the past 17 years. “It changed my life and I owe it all to her,” he says, pointing to Ms. Delahanty. “It’s amazing to see the effects of weight loss. My blood glucose, blood pressure and cholesterol all went down when I lost weight. They go up when my weight goes up.” Now age 66, Tim is just starting to tip into the diabetes range. (Risk also rises with age.)

Ms. Delahanty coaches her patients to reach their goals in doable steps, allowing them to gain confidence and skills. Their new way of living, she emphasizes, “becomes so automatic it’s like brushing your teeth.”

Scouting Menus Online

Tim learned about counting calories and fat grams and making small changes with big effects. She helped him identify foods that put him over his goal. His wife, Roberta, learned how to adapt her Italian recipes. Before eating at a restaurant, Tim looks online at the menu to identify the low-fat dishes, without cream and cheese, he can eat.

The formula is simple. There are 3,500 calories in a pound. To lose a pound a week, says Ms. Delahanty, you need to cut back 500 calories a day. Because fat has more calories than protein or carbohydrates, you get more bang for the buck by reducing fats.

“I used to love potato chips and ate them with every lunch,” Tim admits. He has replaced them with fruit and eats more fruits and vegetables. “But Linda told me that I didn’t have to give up chips, pizza or ice cream completely, which was very important to me,” Tim says. “I can have them and enjoy them, just not too often.”

“People think that the minute they’ve strayed from perfection, they’ve failed,” Ms. Delahanty adds. “Instead, if you eat too many fats one day, eat less the next.”

5 ways to beat
Learn 5 Ways to Beat Diabetes

Wanting to Live Longer

In high school in Roslindale, Mass., Tim was the twin who was in glee club, while his brother, Paul, ran track. Now Tim exercises about 30 minutes a day 5 days a week—jogging, walking and playing golf. He and his wife also go dancing every Friday night.

Paul, in the meantime, lost 25 pounds through diet and exercise after he was diagnosed. He and his wife, Nancy, would walk two miles and ride bikes. But after the first couple of years, his weight started to increase again, and he needed medication to control his diabetes. Retired and living in Florida half the year now, Paul fishes and bowls regularly and eats a low-fat diet. Although he hasn’t experienced complications related to diabetes, he now must give himself regular insulin injections.

“At age 66, I want to live longer, but how much more of life am I willing to give up?” Paul says, adding that there is more to diabetes control than diet and exercise. “I’ve been struggling with this for about 20 years and it’s not easy.”

As the Daly twins have found, it gets harder to lose weight with age, a situation made worse by diabetes.
As the Daly twins have found, it gets harder to lose weight with age, a situation made worse by diabetes.

Putting Research Into Practice

For the first time in 25 years, the dramatic rise in diabetes has reversed. Nationally, new cases had been going up about 5 percent annually but, as of four years ago, have started to decline by 5 percent. “We like to think the Diabetes Prevention Program is part of the reason why,” Dr. Nathan says. He notes, however, that there are still many new cases of diabetes every year, so there is still much work to be done.

In 2013, Mass General redesigned diabetes care provided at all Mass General primary care practices, applying evidence-based approaches. They are ones  effective in the DPP and LookAHEAD studies and that the MGH Diabetes Center uses. For widespread adoption, however, there needs to be less expensive and less time intensive ways to support patients through weight loss.

Ms. Delahanty received a Mass General Clinical Innovation Award grant to conduct a pilot study on the best ways to do this. She found that group sessions helped more patients lose weight than if they met alone with a dietitian.

“People with diabetes feel alone, so it can be very powerful to be with others who have it and hear their experiences and ideas,” she says.

“Starting early in life is important because lifestyle changes may well also improve longevity and cognitive function, something we’re studying now.”

Ms. Delahanty and Deborah Wexler, MD, the co-director of the MGH Diabetes Clinic, obtained $2.5 million from the National Institutes of Health to expand this research.

A Sip at the Fountain

During the 35 years since Dr. Nathan founded the MGH Diabetes Center, he’s headed one research trial after another. The studies reveal the right mix of lifestyle and medications to prevent, control and treat diabetes and its complications.

It gets harder to lose weight as we get older, which is made worse by diabetes, he points out. “Starting early in life is important because lifestyle changes may well also improve longevity and cognitive function, something we’re studying now,” he says. “We haven’t found the fountain of youth, but we are trying to get a little drink at that fountain.”

To learn more about how you can support diabetes research and care at Mass General, please contact us.