The study participants had direct consultation sessions with the study nutritionist, at the beginning of the study and at every monthly follow-up visits. A standard diet according to the ADA guidelines was advised, with 500-1000 kcal/day less (depending on the patient's starting weight and acceptance) than the individual patient's requirement. Special emphasis was placed on avoiding fried food, increasing intake of monounsaturated fats, low fat milk, fibers, vegetables and fruits. Fruits and milk are often avoided by our patients due to the misconception that fruits, except one apple a day, are harmful in diabetes and that milk is "fattening". The patients were also encouraged to take non-cereal diet consisting of low fat milk or yoghurt, fruits, vegetables and green salads, once a week. Each individual was given and explained a detailed individualized diet sheet (in the local language) first by the dietitian and then by the authors. They were asked to undertake some form of aerobic exercise, at least brisk walking (5 kilometers/hour) for 45 minutes daily, or at least 5 days a week. Where available and affordable, they were encouraged to join a health-club/gymnasium where they could do graded aerobic and resistance exercises under supervision. All patients were advised to quit tobacco use in any form. None of our study subjects were in the habit of taking alcohol regularly. Those, who took alcohol, never consumed more than 100ml of spirit per week. Nonnutritive sweeteners were allowed in moderation within the limits of recommendations of ADA. On each subsequent visit, the importance of diet and exercise were re-emphasized by the dietitian, paraclinical staff and the authors. Each case was interviewed in detail about the diet and exercise regimen they were following and corrections, if any, were suggested. Each patient was supplied with printed material in local language about diabetes in general and diet in particular. Drug treatment for hypertension and hyperlipidemia, wherever indicated, were not withheld during the study period.