REVIEW · October 01, 2014
Interventions to Prevent Development of Diabetes
REVIEW · October 01, 2014
TAKE-HOME MESSAGE
- This review discusses the importance of early recognition of prediabetes and early diabetes. The authors recommend early screening for prediabetes and early diabetes, perhaps with a glucose tolerance test similar to that used to test for gestational diabetes, followed by management to keep glucose levels near normal for those who are both high-risk and who are likely to benefit.
- By catching diabetes early in its natural history and intervening, it may be possible to prevent or delay progression of the disease. This review provides recommendations to implement this, although further research involving randomized trials is needed to determine the effectiveness of these approaches.
ABSTRACT
As diabetes develops, we currently waste the first ∼10 years of the natural history. If we found prediabetes and early diabetes when they first presented and treated them more effectively, we could prevent or delay the progression of hyperglycemia and the development of complications. Evidence for this comes from trials where lifestyle change and/or glucose-lowering medications decreased progression from prediabetes to diabetes. After withdrawal of these interventions, there was no “catch-up”-cumulative development of diabetes in the previously treated groups remained less than in control subjects. Moreover, achieving normal glucose levels even transiently during the trials was associated with a substantial reduction in subsequent development of diabetes. These findings indicate that we can change the natural history through routine screening to find prediabetes and early diabetes, combined with management aimed to keep glucose levels as close to normal as possible, without hypoglycemia. We should also test the hypothesis with a randomized controlled trial.
Diabetes Care
We Can Change the Natural History of Type 2 Diabetes
Diabetes Care 2014 Oct 01;37(10)2668-2676, LS Phillips, RE Ratner, JB Buse, SE Kahn