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MADELEINE BRAND, host:

It's MORNING EDITION from NPR News. I'm Madeleine Brand.

STEVE INSKEEP, host:

And I'm Steve Inskeep. Today in Your Health, we begin a look at the way small changes can make a big difference in your life. And that includes small changes in the lives of two men who are genetically the same, even though their routines are not. NPR's Allison Aubrey reports on the significance of one hour of basketball per week.

ALLISON AUBREY: We'll get to the hoops in a minute. But first, I want to introduce you to identical twins Tim and Paul Daly. They've shared a lot in their 60 years: a childhood bedroom, an identical set of genes - including some that predispose them to diabetes - and, of course, the same birthday.

Mr. PAUL and TIM DALY: February 16th, 1949.

Mr. T. DALY: And God bless my mother. She somehow dealt with us over the years, right?

Mr. P. DALY: Been known as the Daly double ever since.

AUBREY: And yes, there's a story about which one is older.

Mr. T. DALY: Paul came out first. He's the oldest by 30 seconds.

Mr. P. DALY: I won the fight between the twins.

Mr. T. DALY: No, no, no. I pushed him out. I definitely pushed him out. I won the fight.

Mr. P. DALY. He tried to strangle me, Allison. He had the cord around my neck.

AUBREY: Competitive? Yes. But each other's greatest defender, too.

Mr. P. DALY: You get into scuffles as you're growing up.

AUBREY: Paul remembers one courtyard scrap from 50 years ago. A game of stickball turned nasty when a neighborhood bully showed up.

Mr. P. DALY: And this kid's on top of me, basically waling away. And I look over, looking for Tim. Where the heck is he?

Mr. T. DALY: As soon as the person would get on top of my brother, I'd jump in. We took care of each other.

AUBREY: In addition to defending each other, Paul and Tim played basketball together. They joined the Army together, learned to love German beer together. And through all of this, they weighed 147 pounds. Almost everything about them was the same until 1974, when life began to take them in different directions.

Mr. T. DALY: Probably, you know, the - so the separation started when we met the women we were going to marry.

Mr. P. DALY: Right.

Mr. T. DALY: And that's when you start to separate a little bit.

AUBREY: So you settled in two different towns outside Boston.

Mr. T. DALY: That's correct.

AUBREY: Tim's dream was to start a business, which he did. First a video store, now real estate. Paul wanted a little more security. He built a career in IT. Both started families. Paul says his wife is an excellent cook, and they liked the Irish-meat-and-potatoes-style dinner.

Mr. P. DALY: So there's one major difference, because you were eating maybe a little more pasta, and I was eating...

Mr. T. DALY: Right.

Mr. P. DALY: ...a little more potatoes. But in those days, my wife worked nights and I worked days, so I would tend to eat probably not what I was supposed to be eating. And the weight, over years, came up.

AUBREY: Both brothers gained weight in their 30s and 40s. It's just that Paul was putting it on faster. He wasn't getting regular exercise, compared to Tim, who kept up with basketball. He played every Tuesday night with a group of friends. Paul says a photo from 1996 was a wake-up call.

Mr. P. DALY: I looked at the picture and I said, oh, my God. So I went from 185 to 220 pounds, which blew my mind because I didn't think of myself at 220 pounds.

AUBREY: And he certainly didn't think diabetes, a disease that tracks closely with obesity. But during his annual physical that year, at age 47, Paul was diagnosed with type 2 diabetes. He hadn't experienced any symptoms other than feeling thirsty, which is typical.

Mr. P. DALY: When you first get diagnosed, it's like a punch in the stomach.

AUBREY: What terrified him was the ugly list of complications that result when diabetes isn't well-managed. Here's physician David Nathan of Massachusetts General Hospital.

Dr. DAVID NATHAN (Director, Massachusetts General Hospital Diabetes Center): The complications include loss of vision, kidney failure, amputations because of an effect on the nervous system, and then also an increase - a really substantial increase - in heart disease and stroke.

AUBREY: And here's the scary part for Tim Daly. His brother's diagnosis meant he was almost certain to develop diabetes, too.

Dr. NATHAN: Because we know that type 2 diabetes is a genetic disease, and since he has an identical twin, he has a risk of developing diabetes that's about 95 percent.

AUBREY: But 14 years after his brother's diagnosis, Tim still does not have diabetes, and he doesn't take any medicine to keep his blood sugar down. So how does he do it? Is it something of a small miracle? Not exactly, says David Nathan.

Dr. NATHAN: It's not that different than many of our other patients.

AUBREY: The patients Nathan's referring to have all gotten onboard with a big, national study that's documenting exactly what it takes in terms of changing everyday lifestyle habits to prevent type 2 diabetes. It focuses on eating less and exercising more, a strategy that's easy to say but tough to follow.

Mr. T. DALY: Can you imagine telling someone you can never have another potato chip as long as you live, or another french fry? It's like, that's - people will give up right away.

AUBREY: That's Tim Daly again. As you might imagine, he wasn't stoked about giving up the foods he loved or his weekly beer and pizza night with his buddies. But back in 1996, he jumped at the chance to take part in the prevention study, because he knew how high his risk was. And a test showed his blood sugar was already higher than normal. He was pre-diabetic.

Mr. T. DALY: Does that motivate you or what? Because I'm the twin, so if I'm getting close, I've got to get refocused.

AUBREY: To Daly's surprise, the changes he needed to make were not as drastic as he feared. Here's how David Nathan describes it.

Dr. NATHAN: This was not a diet. What we try to do is to change - teach people to change their behaviors.

AUBREY: During his first meeting with nutritionist Linda Delahanty, Daly weighed in at 200 pounds - too much for his 5-foot-10 frame. So she gave him two specific goals.

Ms. LINDA DELAHANTY (Nutritionist): He needed to lose 14 pounds, and he needed to reach a target of exercising for 150 minutes per week.

AUBREY: The Tuesday night basketball accounted for the first 60 minutes. To step it up, Tim added in some walks and jogging - a couple of miles a few times a week. When I caught up with him just before snow hit, he was out golfing, walking the course instead of riding in a cart with his buddies.

Mr. T. DALY: What do you think? What do you think of the yardage, huh?

AUBREY: He says it's good exercise.

Oh!

Mr. T. DALY: That's a heck of a shot.

AUBREY: He says people who don't play golf don't get it.

Mr. T. DALY: You hit a little white ball and chase it around? No. You come out with your buddies, you have fun, talk about just, life in general and enjoy the beautiful scenery. We just saw five deer on the fourth hole.

AUBREY: And by the time the round was over, he had walked several miles. Daly says learning to do more exercise in the course of a week was not half as challenging as learning to eat small portions all the time. But he's learned to make that a habit, too. For instance, he knows the rule of thumb on portions of meat: They should be no bigger than a deck of cards. And what about chips?

Mr. T. DALY: Yeah. I can have some potato chips, but I don't take the bag with me. I pour a bit into a cup. That's what I have.

AUBREY: Over time, all of these small changes led to something more significant than just losing the weight.

Ms. DELAHANTY: Losing that 14 pounds actually caused his blood sugars to revert to the normal range from the pre-diabetes range.

AUBREY: Wow. This must be a big surprise to lots of your patients, that such a subtle difference can be the dividing line between diabetes or not.

Ms. DELAHANTY: Right. I think that's what people don't realize. They think they need to lose 50 pounds or 100 pounds.

AUBREY: But in this case, just 14 pounds made the difference. Here, again, is David Nathan.

Dr. NATHAN: Small steps can result in these really large benefits downstream. Just doing a little bit more will help enormously to reverse this. And that's what the diabetes prevention program actually showed.

AUBREY: Nathan says the Daly twins are not an anomaly. Though Paul is living with diabetes, by stepping up his level of exercise and eating better, he's been able to manage the condition and doesn't need to take insulin. The brothers say nothing has changed since the days when they were defending each other from a playground bully.

Mr. P. DALY: We have that special bond and we are truly, truly blessed. ..TEXT: Mr. T. DALY: That, we are.

AUBREY: So you're fighting the diabetes together.

Mr. T. DALY: Yes.

Mr. P. DALY: Yup. And we're going to win it.

AUBREY: It's the kind of attitude that makes David Nathan hopeful.

Dr. NATHAN: You know, we have 1.6 million new cases of diabetes per year in the U.S. now and, you know, we could conceivably - over a decade, even - decrease that by a third. That would be spectacular.

AUBREY: As Nathan sees it, an epidemic could be reversed if lots and lots of people worked to make small changes.

Allison Aubrey, NPR News, Washington.

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INSKEEP: Allison's series of reports is called "Living Well: The Power of Small Changes." And it's supported in part through a fellowship from the Kaiser Family Foundation.

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INSKEEP: It's MORNING EDITION from NPR News.

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