Findings from a study published in the World Journal of Diabetes revealed that implementing measures to manage prediabetes may decrease the risk of developing type 2 diabetes mellitus (T2DM) by as much as 70%.
Several major randomized, controlled trials, including the Diabetes Prevention Program (DPP), the Finnish Diabetes Prevention Study (DPS), and the Da Qing Diabetes Prevention Study (Da Qing study), reveal that lifestyle/behavioral therapy with individualized reduced-calorie meal planning is extremely effective in thwarting or delaying T2DM and improving other cardiometabolic markers (such as blood pressure, lipids, and inflammation).
The most robust clinical evidence on diabetes prevention in the United States came from the DPP trial, which revealed that intensive lifestyle intervention could reduce the risk of incident T2DM by 58% over 3 years. Follow-up of three extensive studies on lifestyle intervention for diabetes prevention revealed a continuous decrease in the risk of progression to T2DM: 39% reduction at 30 years in the Da Qing study, 43% reduction at 7 years in the Finnish DPS, and 34% reduction at 10 years and 27% reduction at 15 years in the U.S. Diabetes Prevention Program Outcomes Study.
The American Diabetes Association (ADA) indicates that in adults with overweight/obesity at elevated risk for T2DM, general care goals should include weight loss or prevention of weight gain, reducing hyperglycemia progression, and attention to cardiovascular risk and associated comorbidities.
2023 ADA Recommendations for Lifestyle/Behavior Changes for Diabetes Prevention
• Refer adults with overweight/obesity at high risk for T2DM, as characterized by the DPP, to an intensive lifestyle/behavior-change program consistent with the DPP to attain and maintain a 7% loss of initial body weight and increase moderate-intensity physical activity (such as brisk walking) to at least 150 minutes/week.
• To prevent diabetes in patients with prediabetes, consider a variety of eating patterns, including a reduction in dietary fat and caloric intake tailored to patient needs. Suggested programs include Mediterranean-style and low-carbohydrate eating plans. Observational studies have also demonstrated that vegetarian, plant-based (may consist of some animal products), and Dietary Approaches to Stop Hypertension (DASH) eating patterns are correlated with a lower risk of developing T2DM.
• Due to their cost-effectiveness, lifestyle/behavior-modification programs should be offered to patients for diabetes prevention in patients at high risk for T2DM. These programs should be covered by third-party payers, and inconsistencies in access should be addressed.
• Based on patient preference, certified technology-assisted diabetes-prevention programs may effectively prevent T2DM and should be considered.
The ADA also suggests screening for and treating modifiable risk factors for cardiovascular disease since prediabetes is associated with an increased risk. Treatment goals and therapies for hypertension and dyslipidemia in the primary prevention of cardiovascular disease for patients with prediabetes should be based on individual cardiovascular risk, and increased awareness is necessary to identify and treat these and other cardiovascular risk factors.
Helpful patient-education resources regarding diabetes prevention include the following:
• ADA Diabetes Prevention (https://diabetes.org/tools-support/diabetes-prevention)
• CDC National Diabetes Prevention Program (www.cdc.gov/diabetes/prevention/index.html)
• AMA Diabetes Prevention Toolkit (https://amapreventdiabetes.org/tools-resources)
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
