Objective-The effectiveness of intentional weight loss in reducing cardiovascular disease (CVD) events in type 2 diabetes is unknown. This report describes one-year changes in CVD risk factors in a trial designed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events.Research Design and Methods-A multi-centered randomized controlled trial of 5,145 individuals with type 2 diabetes, aged 45-74 years, with body mass index ≥25 kg/m 2 (≥27 kg/m 2 if taking insulin). An Intensive Lifestyle Intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared to a Diabetes Support and Education (DSE) condition.Results-Participants assigned to ILI lost an average 8.6% of their initial weight versus 0.7% in DSE group (p<0.001). Mean fitness increased in ILI by 20.9% versus 5.8% in DSE (p<0.001). A greater proportion of ILI participants had reductions in diabetes, hypertension, and lipid-lowering medicines. Mean HbA 1 c dropped from 7.3% to 6.6% in ILI (p<0.001) versus from 7.3% to 7.2% in DSE. Systolic and diastolic pressure, triglycerides, HDL-cholesterol, and urine albumin/creatinine improved significantly more in ILI than DSE participants (all p<0.01).Conclusions-At 1 year, ILI resulted in clinically significant weight loss in persons with type 2 diabetes. This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE. Continued intervention and follow-up will determine whether these changes are maintained and will reduce CVD risk.

Language is powerful and can have a strong impact on perceptions as well as behavior. A task force, consisting of representatives from the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA), convened to discuss language in diabetes care and education. This document represents the expert opinion of the task force. The literature supports the need for a language movement in diabetes care and education. There are effective ways of communicating about diabetes. This article provides recommendations for language used by health care professionals and others when discussing diabetes through spoken or written words—whether directed to people with diabetes, colleagues, or the general public, as well as research questions related to language and diabetes.

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OBJECTIVE -To evaluate the effect of treatment with the dipeptidyl peptidase (DPP)-4 inhibitor vildagliptin on insulin sensitivity and ␤-cell function in subjects with impaired fasting glucose (IFG).RESEARCH DESIGN AND METHODS -A total of 22 subjects with IFG (11 female and 11 male, mean Ϯ SD age 59.6 Ϯ 11.5 years) were treated orally with 100 mg vildagliptin once daily in a single-blind study. Subjects received placebo for 2 weeks (run-in) followed by vildagliptin for 6 weeks (treatment) and then placebo for 2 weeks (washout). A frequently sampled intravenous glucose tolerance test (FSIGT), followed by a 2-h meal tolerance test (MTT), was performed at 2, 8, and 10 weeks. From the FSIGT, the acute insulin response to glucose (AIR g ) and insulin sensitivity index (S I ) were determined and used to compute the disposition index (AIR g ϫ S I ) as a measure of ␤-cell function.RESULTS -Fasting plasma glucose did not change after 6 weeks of vildagliptin treatment. With treatment, mean Ϯ SEM AIR g increased from 224 Ϯ 44 to 286 Ϯ 52 pmol/l (P Ͻ 0.05), and S I improved from 2.8 Ϯ 0.5 to 3.5 Ϯ 0.5 ϫ 10 Ϫ5 ⅐ min Ϫ1 ⅐ pmol Ϫ1 ⅐ l (P Ͻ 0.01), resulting in an increase in the disposition index from 688 Ϯ 180 to 1,164 Ϯ 318 ϫ 10 Ϫ5 /min (P Ͻ 0.05). These effects were not sustained after washout. During the MTT, the incremental area under the glucose curve was significantly decreased after treatment (240 Ϯ 15 vs. 191 Ϯ 14 mmol ⅐ l Ϫ1 ⅐ min Ϫ1 ; P ϭ 0.002), but this effect was not sustained after washout.CONCLUSIONS -The DPP-4 inhibitor vildagliptin improves insulin sensitivity and ␤-cell function, leading to improved postprandial glycemia in subjects with IFG, who are known to have ␤-cell dysfunction. Thus, vildagliptin may prevent progression to diabetes in high-risk subjects.