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Prevention of type 2 diabetes mellitus

Authors
David K McCulloch, MD
R Paul Robertson, MD
Section Editor
David M Nathan, MD
Deputy Editor
Jean E Mulder, MD

INTRODUCTION

Type 2 diabetes mellitus is characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secretion. Although the lifetime risk of type 2 diabetes is high, our ability to predict and prevent type 2 diabetes in the general population is limited. However, individuals at high-risk, including those with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), obesity, close relatives with type 2 diabetes, or who are members of certain ethnic groups (Asian, Hispanic, African American), are appropriate candidates for preventive interventions [1].

The goals of diabetes “prevention” are delaying the onset of diabetes, preserving beta cell function, and preventing or delaying microvascular and perhaps cardiovascular complications. As a therapeutic target, preservation of beta cell function may be particularly important as beta cell failure largely underlies the transition from pre-diabetic states to diabetes (as well as worsening of glycemic control once diabetes has developed).

The prevention of type 2 diabetes mellitus will be reviewed here. The prevalence, risk factors, and screening for type 2 diabetes are discussed elsewhere. (See "Risk factors for type 2 diabetes mellitus" and "Screening for type 2 diabetes mellitus".)

OUR APPROACH

We promote lifestyle changes (healthy diet and regular exercise) to all of our patients. In addition, we measure glycated hemoglobin (A1C) or fasting plasma glucose (FPG) in adults at high risk for diabetes, including individuals >45 years of age with body mass index (BMI) >25 kg/m2 who have one or more additional risk factors for diabetes (eg, family history of diabetes mellitus in a first-degree relative, sedentary lifestyle, gestational diabetes, hypertension, dyslipidemia). If the FPG or A1C value is abnormal, the initial test should be repeated (table 1). (See "Screening for type 2 diabetes mellitus" and "Risk factors for type 2 diabetes mellitus".)

For select patients (age <60 years and/or BMI ≥35 kg/m2, women with a history of gestational diabetes) with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or A1C of 5.7 to 6.4 percent (39 to 46 mmol/mol), in whom lifestyle interventions fail to improve glycemic indices, we suggest metformin for diabetes prevention (table 2). This suggestion is based upon the findings of the Diabetes Prevention Program (DPP), in which metformin was particularly effective in individuals who were younger and more obese (BMI >35 kg/m2) and in women with a history of gestational diabetes. (See 'Diabetes Prevention Program' below and 'Pharmacologic therapy' below.)

                            

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Literature review current through: Nov 2016. | This topic last updated: Mon Jun 13 00:00:00 GMT 2016.
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