Diabetes mellitus type 2 primary prevention
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
There two recommended methods for reducing the risk of type 2 diabetes development. Life style modification is the mainstay for diabetes mellitus prevention, which includes diet considerations as well as regular Physical exercise. Metformin is another adjunctive measure to prevent diabetes in high risk persons.
Primary Prevention
- prevention of diabetes mellitus type 2 is based on two major concepts: Life style modification and pharmacological prevention. Life style modification is more effective than pharmacological intervention. Effects of life style modification usually last longer than pharmacological intervention. [1]
Life style modification
- Studies have shown that 7% weight loss during 6 months in obese individuals is effective for diabetes prevention.[2]
- The recommended pace of weight loss is 1–2 lb/week.[3]
- Calorie goals were calculated by estimating the daily calories needed to maintain the participant’s initial weight and subtracting 500–1,000 calories/day. Reducing caloric intake is of paramount importance for those at high risk for developing type 2 diabetes.
- Reducing fat intake and fat quality is also important in this group.[3]
- Grains may help to prevent type 2 diabetes.[4]
- Higher intakes of nuts, [5] berries[6], yogurt[7], coffee and tea[8] are associated with reduced diabetes risk.
- Conversely, red meats and sugar sweetened beverages are associated with an increased risk of type 2 diabetes.[9]
- 150 min/week of moderate intensity physical activity, such as brisk walking, showed beneficial effects in those with prediabetes.[10]
- Moderate intensity physical activity has been shown to improve insulin sensitivity and reduce abdominal fat in children and young adults.[11][12]
Pharmacologic intervention
- Metformin therapy for prevention of type 2 diabetes should be considered in those with prediabetes, especially for those with BMI >35 kg/m2, age > 60 years, women with prior gestational diabetes mellitus, and/or those with rising A1C despite lifestyle intervention.
References
- ↑ Haw, J. Sonya; Galaviz, Karla I.; Straus, Audrey N.; Kowalski, Alysse J.; Magee, Matthew J.; Weber, Mary Beth; Wei, Jingkai; Narayan, K. M. Venkat; Ali, Mohammed K. (2017). “Long-term Sustainability of Diabetes Prevention Approaches”. JAMA Internal Medicine. 177 (12): 1808. doi:10.1001/jamainternmed.2017.6040. ISSN 2168-6106.
- ↑ Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J (2006). “Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study”. Lancet. 368 (9548): 1673–9. doi:10.1016/S0140-6736(06)69701-8. PMID 17098085.
- ↑ 3.0 3.1 Anderson JW, Konz EC (2001). “Obesity and disease management: effects of weight loss on comorbid conditions”. Obes Res. 9 Suppl 4: 326S–334S. doi:10.1038/oby.2001.138. PMID 11707561.
- ↑ Montonen J, Knekt P, Järvinen R, Aromaa A, Reunanen A (2003). “Whole-grain and fiber intake and the incidence of type 2 diabetes”. Am. J. Clin. Nutr. 77 (3): 622–9. PMID 12600852.
- ↑ Afshin A, Micha R, Khatibzadeh S, Mozaffarian D (2014). “Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis”. Am. J. Clin. Nutr. 100 (1): 278–88. doi:10.3945/ajcn.113.076901. PMC 4144102. PMID 24898241.
- ↑ Mursu J, Virtanen JK, Tuomainen TP, Nurmi T, Voutilainen S (2014). “Intake of fruit, berries, and vegetables and risk of type 2 diabetes in Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study”. Am. J. Clin. Nutr. 99 (2): 328–33. doi:10.3945/ajcn.113.069641. PMID 24257723.
- ↑ Chen M, Sun Q, Giovannucci E, Mozaffarian D, Manson JE, Willett WC, Hu FB (2014). “Dairy consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis”. BMC Med. 12: 215. doi:10.1186/s12916-014-0215-1. PMC 4243376. PMID 25420418.
- ↑ Mozaffarian D (2016). “Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review”. Circulation. 133 (2): 187–225. doi:10.1161/CIRCULATIONAHA.115.018585. PMC 4814348. PMID 26746178.
- ↑ Ley SH, Hamdy O, Mohan V, Hu FB (2014). “Prevention and management of type 2 diabetes: dietary components and nutritional strategies”. Lancet. 383 (9933): 1999–2007. doi:10.1016/S0140-6736(14)60613-9. PMC 4751088. PMID 24910231.
- ↑ O’Brien MJ, Perez A, Scanlan AB, Alos VA, Whitaker RC, Foster GD, Ackermann RT, Ciolino JD, Homko C (2017). “PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin”. Am J Prev Med. doi:10.1016/j.amepre.2017.01.008. PMID 28237635.
- ↑ Fedewa MV, Gist NH, Evans EM, Dishman RK (2014). “Exercise and insulin resistance in youth: a meta-analysis”. Pediatrics. 133 (1): e163–74. doi:10.1542/peds.2013-2718. PMID 24298011.
- ↑ Davis CL, Pollock NK, Waller JL, Allison JD, Dennis BA, Bassali R, Meléndez A, Boyle CA, Gower BA (2012). “Exercise dose and diabetes risk in overweight and obese children: a randomized controlled trial”. JAMA. 308 (11): 1103–12. doi:10.1001/2012.jama.10762. PMC 3487697. PMID 22990269.
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