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The prevention of type 2 diabetes

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 382–393 (2008)Cite this article

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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Authors and Affiliations

  1. JP Crandall is Associate Professor of Clinical Medicine at Albert Einstein College of Medicine, Bronx, NY.,

    Jill P Crandall

  2. WC Knowler is Chief of the Diabetes Epidemiology and Clinical Research Section of the National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.,

    William C Knowler

  3. SE Kahn is Professor of Medicine at Veterans' Affairs Puget Sound Health Care System, Seattle, WA.,

    Steven E Kahn

  4. D Marrero is the JO Ritchey Professor of Medicine at Indiana University, IN.,

    David Marrero

  5. JC Florez is an Assistant in Medicine at the Center for Human Genetic Research and Diabetes Unit, Massachusetts General Hospital, Boston, MA.,

    Jose C Florez

  6. GA Bray is Professor of Medicine at Louisiana State University, Baton Rouge, LA.,

    George A Bray

  7. SM Haffner is Professor of Internal Medicine in the Departments of Medicine and Clinical Epidemiology, University of Texas Health Science Center, San Antonio, TX.,

    Steven M Haffner

  8. M Hoskin is Program Coordinator of the Diabetes Prevention Program Outcomes Study in the Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes, Digestive and Kidney Diseases, Phoenix, AZ.,

    Mary Hoskin

  9. DM Nathan is Director of the Diabetes Center and General Clinical Research Center in Harvard Medical School, Boston, MA, USA.,

    David M Nathan

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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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Crandall, J., Knowler, W., Kahn, S. et al. The prevention of type 2 diabetes. Nat Rev Endocrinol 4, 382–393 (2008). https://doi.org/10.1038/ncpendmet0843

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