Diabetes prevention

Diabetes often diagnosed in a relatively late stage of disease, at a point when many patients have already developed complications: therefore prevention of diabetes is a major goal.

Since type II diabetes is characterized by two metabolic defects: insulin resistance, coupled with impaired insulin secretion by beta cells in the pancreas.

Strategies that target the two above mechanisms by improving insulin sensitivity in protecting beta cell function are the focus of preventing diabetes.

Weight loss and physical activity, and some medications can improve both insulin sensitivity and secretion.

Diet, physical activity, and behavioral therapy should be designed to achieve and maintain at least 5% weight loss: additional weight loss usually results in for the improvements in control of diabetes and cardiovascular risk.

Lifestyle intervention to prevent diabetes has not prevented cardiovascular events, not even after 10-20 years of follow-up.

Mediterranean diet supplemented with extra-virgin olive oil results in a 40% relative reduction in diabetes risk compared with the control group in individuals 55-80 years (PREDIMED).

In a study in the Chinese community among 577 men and women with impair glucose tolerance randomized to diet, exercise, or both: after six years of follow-up all three interventions were associated with the risk reductions of 31 to 46% compared to an untreated control group (Pan XR).

In the above study, most patients went on to develop diabetes, although the prevalence was lower in the intervention group, 80% compared to 93% in the placebo group (Li G).

In the Finnish Diabetes Prevention Study 522 overweight patients were randomized to lifestyle modifications or to a control group: at a three-year follow-up: there was a 50% reduction in cumulative risk in the study group compared to the control group, moderate to vigorous exercise reduced the incidence by 63-69%, and in an extended three year follow-up the intensive lifestyle group maintained a 36% relative reduction in diabetes incidence (Lindstrom J).

Metformin was associated with a 31% reduction in diabetes compared to placebo (DDP Research Group).

Metformin most effective in preventing diabetes in more obese individuals with BMI greater than 35kg/m2 with a reduction of diabetic incidence of 53% and in patients < 45 years of age with a 44% reduction (DDP Research Group).

Metformin not significantly beneficial to prevent diabetes for individuals 60-85 years of age.

Metformin’s effectiveness in preventing diabetes in part attributable to associated weight loss(DDP Research Group).

Metformin, after 10 years maintained weight loss of 2.5 kg, and was associated with 18% reduction in diabetes incidence compared to placebo (DDP Research Group).

Acarbose, an alpha-glucosidase inhibitor, in the Study to Prevent Non-Insulin Dependent Diabetes (STOP-NIDDM trial): 1429 patients with glucose intolerance on acarbose vs. placebo-associated with a 25% reduction in diabetes incidence.

In a randomized trial in 9306 patients with impaired glucose tolerance and cardiovascular disease or cardiovascular risk and given placebo vs. nateglinide: nateglinide did not significantly reduce cumulative incidence of diabetes or cardiovascular outcomes (NAVIGATOR STUDY GROUP).

In Diabetes Prevention Trial-Type 1, who treatment with oral insulin did not result in treatment of prevention of type I diabetes, although it may have prevented the disease in persons with concentration of insulin antibodies ( Skyler JS et al).

DiaPep 277, a heat- shock peptide had some positive effects in newly diagnosed type I diabetes in adults, but not in children.

Treatment with 65-KD isoform of glutamic acid decarboxylase (GADA65) formulated with aLUM (GAD-alum) is associated with a preservation of fasting C-peptide levels at 30 months after treatment and a preserve stimulated C-peptide level at 15 months (Ludvigsson J et al).

In a study of 334 patients age 10-20 years of age with type I diabetes, fasting C-a high levels of more than 0.3 ng millimeter and detectable serum GAD65 autoantibodies treated with GAD-alum at varying doses as schedules compared with placebo: GAD-alum it not significantly reduce the loss of stimulated C-peptide or improve clinical outcomes over a 15 month period (Ludvigson J et al).

The Look AHEAD (Action for Health for Diabetes), a large randomized controlled trial of intensive lifestyle intervention among adults with type II diabetes: involved 4503 adults with body mass index of 25 or higher and type II diabetes randomly assigned intensive lifestyle intervention.

In the above study intensive lifestyle intervention may be associated with the partial diabetes remission in patients with type II diabetes, particularly those diabetes is of short duration, who have a lower hemoglobin A-1 C level, and do not yet require insulin therapy (Gregg EW et al).

In the above study complete remission associated with intensive lifestyle intervention, when defined by glucose normalization without need for drugs, is a rare event.

Partial remissions defined as a transition to prediabetic or normal glucose levels without drug treatment is an attainable goal for some patients with type II diabetes, and as many as 11.5% of participants had partial or complete remission within the first year of intervention and 7% in a partial complete remission after four years.

In the above trial improved risk factor profiles did not translate into lower rates of nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, or death compared to conventional diabetes treatment and the Look-ahead trial was ended as it did not decrease the occurrence of cardiovascular events.

Evidence exists that bariatric surgery is more effective than medical or lifestyle interventions for weight loss and diabetes remission.

In a recent analysis of severely obese patients with diabetes, the adjusted probability of initial remission was 12-24 fold greater for patients treated with bariatric surgery than for the patients who received usual medical care alone(Arteburn DE et al).

Physical activity may lower risk of progression of gestational diabetes to type 2 DM (Bao W et al).

Edible oils rich in mono and polyunsaturated fatty acids favorably affect diabetes risk.

Use of sesame oil as cooking oil reduces blood glucose, glycated hemolobin and cholesterol helping to control type two diabetes.

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