Reducing the Risk of Developing Diabetes
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee
Thomas Ransom MD, MSc, FRCPC Ronald Goldenberg MD, FRCPC, FACE Amanda Mikalachki RN, CDE Ally P.H. Prebtani BScPhm, MD, FRCPC Zubin Punthakee MD, MSc, FRCPC
- As safe and effective preventive therapies for type 1 diabetes have not yet been identified, any attempts to prevent type 1 diabetes should be undertaken only within the confines of formal research protocols.
- Intensive and structured lifestyle modification that results in loss of approximately 5% of initial body weight can reduce the risk of progression from impaired fasting glucose or impaired glucose tolerance to type 2 diabetes by almost 60%.
- Progression from prediabetes to type 2 diabetes can also be reduced by pharmacological therapy with metformin (∼30% reduction), acarbose (∼30% reduction) and thiazolidinediones (∼60% reduction).
Highlights of Revisions
The chapter has been renamed “Reducing the Risk of Devel- oping Type 1 and Type 2 Diabetes” to acknowledge that all strategies that have been termed “prevention” are actually strategies to reduce the risk of development since prevention may not be possible in many cases.
Recommendations for implementing lifestyle modification to reduce the risk of type 2 diabetes now include glycated hemoglobin (A1C) levels.
Thiazolidinedione has been removed from the pharmacological therapy recommendation for individuals with impaired glucose tolerance (IGT). Only metformin and acarbose are now included.
- A structured program of lifestyle modification that includes moderate weight loss and regular physical activity should be implemented to reduce the risk of type 2 diabetes in individuals with IGT [Grade A, Level 1A (1,2)] and IFG [Grade B, Level 2 (3)] and A1C 6.0%–6.4% [Grade D, Consensus].
- In individuals with IGT, pharmacological therapy with metformin [Grade A, Level 1A (2)] or acarbose [Grade A, Level 1A (4)] may be used to reduce the risk of type 2 diabetes.
A1C, glycated hemoglobin; IFG, impaired fasting glucose; IGT, impaired glucose tolerance.
Tuomilehto J, Lindström J, Eriksson JG, et al, Finnish Diabetes Prevention Study 91 Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343e50.
Knowler WC, Barrett-Connor E, Fowler SE, et al, Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393e403.
Saito T, Watanabe M, Nishida J, et al, for the Zensharen Study for Prevention of Lifestyle Diseases Group. Lifestyle modification and prevention of type 2 diabetes in overweight Japanese with impaired fasting glucose levels: a randomized 97 controlled trial. Arch Intern Med 2011;171:1352e60.
Chiasson JL, Josse RG, Gomis R, et al, STOP-NIDDM Trial Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 2002;359:2072e7.
Reproduced with permission from Canadian Journal of Diabetes
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