Recommendations
* Individuals at high risk for developing diabetes need to become aware of the benefits of modest weight loss and participating in regular physical activity. (A)
* Patients with IGT should be given counseling on weight loss as well as instruction for increasing physical activity. (A)
* Patients with IFG should be given counseling on weight loss as well as instruction for increasing physical activity. (E)
* Follow-up counseling appears important for success. (B)
* Monitoring for the development of diabetes in those with pre-diabetes should be performed every 1??ger and more obese but had nearly identical glucose intolerance compared with subjects in the Finnish study. About 45% of the participants were from minority groups (e.g., African American, Hispanic), and 20% were 60 years of age. Subjects were randomized to one of three intervention groups, which included the intensive nutrition and exercise counseling (“lifestyle”) group or either of two masked medication treatment groups: the biguanide metformin group or the placebo group. The latter interventions were combined with standard diet and exercise recommendations. After an average follow-up of 2.8 years, a 58% relative reduction in the progression to diabetes was observed in the lifestyle group and a 31% relative reduction in the progression of diabetes was observed in the metformin group compared with control subjects. On average, 50% of the lifestyle group achieved the goal of 7% weight reduction and 74% maintained at least 150 min/week of moderately intense activity. In the troglitazone arm of the DPP (discontinued after a mean of 0.9 years when the drug was withdrawn from the market), troglitazone markedly reduced the incidence of diabetes during the period the drug was given.
In the Da Qing Study, men and women from health care clinics in the city of Da Qing, China, were screened with OGTT, and those with IGT were randomized by clinic to a control group or to one of three active treatment groups: diet only, exercise only, or diet plus exercise. Subjects were reexamined biannually, and after an average of 6 years?? ability to delay type 2 diabetes when added to lifestyle change in a group with BMI 30 kg/m2 with or without IGT. After 4 years of treatment, the effect of orlistat addition corresponded to a 45% risk reduction in the IGT group, with no effect observed in those without IGT.
Our knowledge of the early stages of hyperglycemia that portend the diagnosis of diabetes, and the recent success of major intervention trials, clearly show that individuals at high risk can be identified and diabetes delayed, if not prevented. The cost-effectiveness of intervention strategies is unclear, but the huge burden resulting from the complications of diabetes and the potential ancillary benefits of some of the interventions suggest that an effort to prevent diabetes is worthwhile.
Lifestyle modification
In well-controlled studies that included a lifestyle intervention arm, substantial efforts were necessary to achieve only modest changes in weight and exercise, but those changes were sufficient to achieve an important reduction in the incidence of diabetes. In the Finnish Diabetes Prevention Study, weight loss averaged 9.2 lb at 1 year, 7.7 lb after 2 years, and 4.6 lb after 5 years; “moderate exercise,” such as brisk walking, for 30 min/day was suggested. In the Finnish study, there was a direct relationship between adherence with the lifestyle intervention and the reduced incidence of diabetes.
In the DPP, the lifestyle group lost 12 lb at 2 years and 9 lb at 3 years (mean weight loss for the study duration was 12 lb or 6% of initial body weight). In both of these studies, most of the participants were obese (BMI >30 kg/m2).
A low-fat (<25% fat) intake was recommended; if reducing fat did not produce weight loss to goal, calorie restriction was also recommended. Participants weighing 120??n was as effective as lifestyle modification in individuals aged 24??te for, or routinely used in addition to, lifestyle modification to prevent diabetes. Public health messages, health care professionals, and health care systems should all encourage behavior changes to achieve a healthy lifestyle. Further research is necessary to understand better how to facilitate effective and efficient programs for the primary prevention of type 2 diabetes.
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AMERICAN DIABETES ASSOCIATION
DIABETES CARE, VOLUME 27, SUPPLEMENT 1, JANUARY 2004
References
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