The prevention of type 2 diabetes

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Abstract

Type 2 diabetes mellitus (T2DM) affects more than 7% of adults in the US and leads to substantial personal and economic burden. In prediabetic states insulin secretion and action—potential targets of preventive interventions—are impaired. In trials lifestyle modification (i.e. weight loss and exercise) has proven effective in preventing incident T2DM in high-risk groups, although weight loss has the greatest effect. Various medications (e.g. metformin, thiazolidinediones and acarbose) can also prevent or delay T2DM. Whether diabetes-prevention strategies also ultimately prevent the development of diabetic vascular complications is unknown, but cardiovascular risk factors are favorably affected. Preventive strategies that can be implemented in routine clinical settings have been developed and evaluated. Widespread application has, however, been limited by local financial considerations, even though cost-effectiveness might be achieved at the population level.

Key Points

  • Type 2 diabetes mellitus is a common chronic disease that is responsible for enormous human and financial costs

  • Lifestyle modification (i.e. modest weight loss and increased physical activity) is the most consistently effective approach to diabetes prevention

  • Medications, including metformin, acarbose and thiazolidinediones, are effective therapies for preventing or delaying diabetes

  • Interventions are effective across different ages and ethnic groups

  • Application of these findings to public-health initiatives has been slow, at least partly because of their financial implications

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Acknowledgements

The authors thank G Trandafirescu and H Shamoon for their valuable assistance in the preparation of this manuscript.

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Correspondence to Jill P Crandall.

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Competing interests

Steven M Haffner has been a member of the advisory boards for AstraZeneca, GlaxoSmithKline and Merck. He is a member of the speakers' bureau for GlaxoSmithKline, Merck, Novartis and Pfizer. He has also been a consultant and received research support form Novartis and Pfizer.

Steven E Kahn has been a consultant, received research funding and has been a member of the speakers' bureau for GlaxoSmithKline.

The other authors declared no competing interests.

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