The study upon which this story is based is very complicated and riddled with caveats. Some of the results baffle its authors. The study’s simple but narrow conclusion is this: A few years of diet and exercise education/support appears to reduce risk of type 2 diabetes in a high risk population over 10 years.
But the story fails by not discussing the findings with experts who do understand it and could explain the implications and applications of the data. The story talks only to the proverbial Area Man and cribs written statements from two remote experts. That’s insufficient. One is tempted to suggest it’s the result of reporters not having enough time or newsroom support to do their jobs thoroughly.
The report also fails to connect the dots between the study and the readers. By failing to discuss costs and availability of lifestyle interventions–or to describe what kinds of interventions the study participants received–it misses a chance to serve its readers who, demographically speaking, are very likely to be in the high-risk group the study focuses on.
The reporter should be commended for one thing: Including an anecdote from someone who has a family history of diabetes, participated in the program and. . .got diabetes anyway. Lifestyle helps him manage, but did not prevent, the disease. An excellent reality check.
Again, the story misses an opportunity to say how much it costs to participate in a diabetes prevention program–or, for that matter, to take metformin.
A creative story could then have compared those costs to the costs of managing diabetes.
During a time when costs of health care are so much in the public’s mind, stories should always probe the question of costs vs benefits.
We have two problems with how the study results were presented:
The story fails to mention the side effects of metformin, which include gastro-intestinal side effects that can inhibit compliance. A serious condition, lactic acidosis, is a rare but significant side effect. It’s contraindicated for people with kidney disease, congestive heart failure and a few other conditions.
The study on which the story is based follows a complicated protocol with a three-year randomized, placebo-controlled phase and 7 years of follow up. During the follow-up phase all participants followed were offered lifestyle interventions. As a result, as the authors admit, it’s hard to draw firm conclusions beyond the simplest top-line assertion that lifestyle intervention and metformin appear to reduce or delay diabetes in high-risk patients.
The story could have been clearer about the complexity and limitations of the study, and the fact that the researchers themselves cannot explain some of the findings. [The NIH press release did.]
Still, the story receives a satisfactory rating, if barely.
The story does nothing to exaggerate the prevalence or severity of type 2 diabetes.
The sourcing in this story is very thin. The only live source is a study participant.
The quote from a local doctor involved with the study comes from a written statement. The second quote is from an editorial published with the study in Lancet.
The basic options for reducing risk of diabetes–lifestyle changes and medication–are built into the study design.
But the story fails to describe the lifestyle modifications in sufficient detail. How often did people exercise? What did they eat? How compliant were they? Readers should have had a few details.
The story could have also mentioned the growing evidence on weight loss and bariatric surgery as ways to prevent type 2 diabetes.
The story doesn’t mention how and where diabetes prevention programs are available.
Lifestyle-modification diabetes prevention programs are a staple offering of hospitals, community centers, insurance companies and corporate wellness programs. The article could at least have mentioned this to allow readers to follow up if they wanted to.
No claim of novelty is made for the lifestyle or drug interventions.
There’s no evidence the story depended on information in the press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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