Prevention of type 2 diabetes

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Prevention of type 2 diabetes can be achieved with both lifestyle changes and use of medication. [1] The American Diabetes Association categorizes people with prediabetes, who have glycemic levels higher than normal but do not meet criteria for diabetes, as a high-risk group. Without intervention, people with prediabetes progress to type 2 diabetes with a 5% to 10% rate. Diabetes prevention is achieved through weight loss and increased physical activity, [2] which can reduce the risk of diabetes by 50% to 60%. [3]

Contents

Lifestyle

Many interventions to promote healthy lifestyles have been shown to prevent diabetes. A combination of diet and physical activity promotion through counselling and support programs decrease weight, improve systolic blood pressure, improve cholesterol levels and decrease risk of diabetes. [3]

Increasing physical activity may be helpful in preventing type 2 diabetes, particularly if undertaken soon after a carbohydrate-rich meal that increases blood sugar levels. [4] [5] [6] The American Diabetes Association (ADA) recommends maintaining a healthy weight, getting at least 2+1⁄2 hours of exercise per week (several brisk sustained walks appear sufficient), having a modest fat intake (around 30% of energy supply should come from fat), [7] and eating sufficient fiber (e.g., from whole grains).

Numerous clinical studies have shown that resistant starch increases insulin sensitivity, independent of the glycemic response of the food [8] [9] and may reduce the risk of type 2 diabetes. [10] The U.S. Food and Drug Administration requires claims that resistant starch can reduce the risk of type 2 diabetes to be qualified with a declaration that scientific evidence in support of this claim is limited. [11]

Foods with low glycemic index, rich in fiber and other important nutrients, are recommended, notwithstanding insufficient evidence. [12]

Study group participants whose "physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes". [13]

Various sources suggest an influence of dietary fat types. Positive effects of unsaturated fats have been asserted on theoretical grounds and observed in animal feeding studies. Hydrogenated fats are universally considered harmful, mainly because of their well-known effect on cardiovascular risk factors. [14]

Numerous studies suggest connections between some aspects of type 2 diabetes with ingestion of certain foods or with some drugs. Breastfeeding may also be associated with the prevention of type 2 diabetes in mothers. [15]

Some evidence relates consumption of coffee with prevention of type 2 diabetes. However, it is unclear if coffee causes any change in the risk of diabetes. This is true regardless of if it is caffeinated/decaffeinated, consumed with/without sugar, or potboiled or not. [16]

Medications

Some studies have shown delayed progression to diabetes in predisposed patients through prophylactic use of metformin, [17] [5] rosiglitazone, [18] or valsartan. [19] Lifestyle interventions are, however, more effective than metformin alone at preventing diabetes regardless of weight loss, [20] though evidence suggests that lifestyle interventions and metformin together can be effective treatment in patients who are at a higher risk of developing diabetes. [17]

A Cochrane systematic review assessed the effect of alpha-glucosidase inhibitors in people with impaired glucose tolerance, impaired fasting blood glucose, elevated glycated hemoglobin A1c (HbA1c). [21] It was found that acarbose appeared to reduce incidence of diabetes mellitus type 2 when compared to placebo; however, there was no conclusive evidence that acarbose compared to diet and exercise, metformin, placebo, no intervention improved all-cause mortality, reduced or increased risk of cardiovascular mortality, serious or non-serious adverse events, non-fatal stroke, congestive heart failure, or non-fatal myocardial infarction. [21] The same review found that there was no conclusive evidence that voglibose compared to diet and exercise or placebo reduced incidence of diabetes mellitus type 2, or any of the other measured outcomes. [21]

Many other medications are well known to modify risk of diabetes 2, although in most cases they are prescribed for reasons unrelated to diabetes 2. In patients on hydroxychloroquine for rheumatoid arthritis, incidence of diabetes was reduced by 77%, though causal mechanisms are unclear. [22] Dopamine receptor agonists are also known to improve glycemic control, reduce insulin resistance and help controlling body weight. [23]

Co-morbidities

People with mental health disorders are at a higher risk of developing type 2 diabetes. The most effective way to prevent type 2 diabetes in people with mental disorders is not clear; considerations include pharmacological interventions, behavior changes, and organizational interventions. [24]

Programmes

Several countries have established more and less successful national programmes to improve prevention and treatment of diabetes. [25] In the UK, the NHS's diabetes prevention programme Healthier You offers personalised face-to-face and digital services. [26] Assessment of the programme is ongoing, but based on the first 36,000 patients, it seems that those who complete the programme manage to reduce their blood sugar levels and lose weight. [27] [28] At the same time, only 1 in 5 people complete the whole 9-month programme. [29] [30] A study of 18,470 people who had been referred to the programme found that they had a 20% reduced risk of developing diabetes. [31] [32]

Related Research Articles

Insulin resistance (IR) is a pathological condition in which cells in insulin-sensitive tissues in the body fail to respond normally to the hormone insulin or downregulate insulin receptors in response to hyperinsulinemia.

<span class="mw-page-title-main">Hyperglycemia</span> Too much blood sugar, usually because of diabetes

Hyperglycemia or hyperglycaemia is a condition in which an excessive amount of glucose (glucotoxicity) circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/L (200 mg/dL), but symptoms may not start to become noticeable until even higher values such as 13.9–16.7 mmol/L (~250–300 mg/dL). A subject with a consistent fasting blood glucose range between ~5.6 and ~7 mmol/L is considered slightly hyperglycemic, and above 7 mmol/L is generally held to have diabetes. For diabetics, glucose levels that are considered to be too hyperglycemic can vary from person to person, mainly due to the person's renal threshold of glucose and overall glucose tolerance. On average, however, chronic levels above 10–12 mmol/L (180–216 mg/dL) can produce noticeable organ damage over time.

<span class="mw-page-title-main">Type 2 diabetes</span> Form of diabetes mellitus

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Other symptoms include increased hunger, having a sensation of pins and needles, and sores (wounds) that heal slowly. Symptoms often develop slowly. Long-term complications from high blood sugar include heart disease, stroke, diabetic retinopathy, which can result in blindness, kidney failure, and poor blood flow in the lower-limbs, which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

<span class="mw-page-title-main">Metformin</span> Medication used to treat diabetes

Metformin, sold under the brand name Glucophage, among others, is the main first-line medication for the treatment of Type 2 diabetes, particularly in people who are overweight. It is also used in the treatment of polycystic ovary syndrome, and is sometimes used as an off-label adjunct to lessen the risk of metabolic syndrome in people who take antipsychotics. It has also been shown to inhibit inflammation, and is not associated with weight gain. Metformin is taken orally.

Drugs used in diabetes treat diabetes mellitus by decreasing glucose levels in the blood. With the exception of insulin, most GLP-1 receptor agonists, and pramlintide, all diabetes medications are administered orally and are thus called oral hypoglycemic agents or oral antihyperglycemic agents. There are different classes of hypoglycemic drugs, and selection of the appropriate agent depends on the nature of diabetes, age, and situation of the person, as well as other patient factors.

<span class="mw-page-title-main">Gestational diabetes</span> Exercise and Obesity Management During Pregnancy

Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, obesity increases the rate of pre-eclampsia, cesarean sections, and embryo macrosomia, as well as gestational diabetes. Babies born to individuals with poorly treated gestational diabetes are at increased risk of macrosomia, of having hypoglycemia after birth, and of jaundice. If untreated, diabetes can also result in stillbirth. Long term, children are at higher risk of being overweight and of developing type 2 diabetes.

<span class="mw-page-title-main">Sulfonylurea</span> Class of organic compounds used in medicine and agriculture

Sulfonylureas or sulphonylureas are a class of organic compounds used in medicine and agriculture. The functional group consists of a sulfonyl group (-S(=O)2) with its sulphur atom bonded to a nitrogen atom of a ureylene group (N,N-dehydrourea, a dehydrogenated derivative of urea). The side chains R1 and R2 distinguish various sulfonylureas. Sulfonylureas are the most widely used herbicide.

<span class="mw-page-title-main">Acarbose</span> Chemical compound

Acarbose (INN) is an anti-diabetic drug used to treat diabetes mellitus type 2 and, in some countries, prediabetes. It is a generic sold in Europe and China as Glucobay, in North America as Precose, and in Canada as Prandase.

Steroid-induced diabetes is characterized as an unusual rise in blood sugar that is linked to the use of glucocorticoids in a patient who may or may not have had diabetes in the past.

The main goal of diabetes management is to keep blood glucose (BG) levels as normal as possible. If diabetes is not well controlled, further challenges to health may occur. People with diabetes can measure blood sugar by various methods, such as with a BG meter or a continuous glucose monitor, which monitors over several days. Glucose can also be measured by analysis of a routine blood sample. Usually, people are recommended to control diet, exercise, and maintain a healthy weight, although some people may need medications to control their blood sugar levels. Other goals of diabetes management are to prevent or treat complications that can result from the disease itself and from its treatment.

<span class="mw-page-title-main">Dipeptidyl peptidase-4 inhibitor</span> Enzyme blocker and diabetes treatment drug

Inhibitors of dipeptidyl peptidase 4 are a class of oral hypoglycemics that block the enzyme dipeptidyl peptidase-4 (DPP-4). They can be used to treat diabetes mellitus type 2.

Alpha-glucosidase inhibitors (AGIs) are oral anti-diabetic drugs used for diabetes mellitus type 2 that work by preventing the digestion of carbohydrates. Carbohydrates are normally converted into simple sugars (monosaccharides) by alpha-glucosidase enzymes present on cells lining the intestine, enabling monosaccharides to be absorbed through the intestine. Hence, alpha-glucosidase inhibitors reduce the impact of dietary carbohydrates on blood sugar.

A diabetic diet is a diet that is used by people with diabetes mellitus or high blood sugar to minimize symptoms and dangerous complications of long-term elevations in blood sugar.

<span class="mw-page-title-main">Dapagliflozin</span> Diabetes medication

Dapagliflozin, sold under the brand names Farxiga (US) and Forxiga (EU) among others, is a medication used to treat type 2 diabetes. It is also used to treat adults with heart failure and chronic kidney disease. It reversibly inhibits sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.

<span class="mw-page-title-main">Prediabetes</span> Predisease state of hyperglycemia with high risk for diabetes

Prediabetes is a component of metabolic syndrome and is characterized by elevated blood sugar levels that fall below the threshold to diagnose diabetes mellitus. It usually does not cause symptoms but people with prediabetes often have obesity, dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension. It is also associated with increased risk for cardiovascular disease (CVD). Prediabetes is more accurately considered an early stage of diabetes as health complications associated with type 2 diabetes often occur before the diagnosis of diabetes.

<span class="mw-page-title-main">Canagliflozin</span> Chemical compound

Canagliflozin, sold under the brand name Invokana among others, is a medication used to treat type 2 diabetes. It is used together with exercise and diet. It is not recommended in type 1 diabetes. It is taken by mouth.

Empagliflozin, sold under the brand name Jardiance, among others, is an antidiabetic medication used to improve glucose control in people with type 2 diabetes. It is taken by mouth.

<span class="mw-page-title-main">Diabetes</span> Group of endocrine diseases characterized by high blood sugar levels

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects. Classic symptoms include thirst, polyuria, weight loss, and blurred vision. If left untreated, the disease can lead to various health complications, including disorders of the cardiovascular system, eye, kidney, and nerves. Diabetes accounts for approximately 4.2 million deaths every year, with an estimated 1.5 million caused by either untreated or poorly treated diabetes.

SGLT2 inhibitors are a class of medications that inhibit sodium-glucose transport proteins in the nephron, unlike SGLT1 inhibitors that perform a similar function in the intestinal mucosa. The foremost metabolic effect of this is to inhibit reabsorption of glucose in the kidney and therefore lower blood sugar. They act by inhibiting sodium/glucose cotransporter 2 (SGLT2). SGLT2 inhibitors are used in the treatment of type 2 diabetes. Apart from blood sugar control, gliflozins have been shown to provide significant cardiovascular benefit in people with type 2 diabetes. As of 2014, several medications of this class had been approved or were under development. In studies on canagliflozin, a member of this class, the medication was found to enhance blood sugar control as well as reduce body weight and systolic and diastolic blood pressure.

Bexagliflozin, sold under the brand name Brenzavvy, is an antidiabetic medication used to improve glycemic control in adults with type 2 diabetes. It is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that is taken by mouth.

References

  1. ↑ Raina Elley C, Kenealy T (December 2008). "Lifestyle interventions reduced the long-term risk of diabetes in adults with impaired glucose tolerance". Evidence-Based Medicine. 13 (6): 173. doi:10.1136/ebm.13.6.173. PMID   19043031. S2CID   26714233.
  2. ↑ Alustiza E, Perales A, Mateo-Abad M, Ozcoidi I, Aizpuru G, Albaina O, Vergara I (September 2021). "Tackling risk factors for type 2 diabetes in adolescents: PRE-STARt study in Euskadi". Anales de Pediatria. 95 (3). Anales de Pediatría: 186–196. doi: 10.1016/j.anpedi.2020.11.001 . PMID   34384737.
  3. 1 2 Balk EM, Earley A, Raman G, Avendano EA, Pittas AG, Remington PL (September 2015). "Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force". Annals of Internal Medicine. 163 (6): 437–451. doi: 10.7326/M15-0452 . PMC   4692590 . PMID   26167912.
  4. ↑ Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, et al. (Finnish Diabetes Prevention Study Group) (November 2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study". Lancet. 368 (9548): 1673–1679. doi:10.1016/S0140-6736(06)69701-8. PMID   17098085. S2CID   24056136.
  5. 1 2 Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, et al. (Diabetes Prevention Program Research Group) (February 2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin". The New England Journal of Medicine. 346 (6): 393–403. doi:10.1056/NEJMoa012512. PMC   1370926 . PMID   11832527.
  6. ↑ Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, et al. (November 2009). "10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study". Lancet. 374 (9702): 1677–1686. doi:10.1016/S0140-6736(09)61457-4. PMC   3135022 . PMID   19878986.
  7. ↑ Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. (December 2010). "Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement". Diabetes Care. 33 (12). American Diabetes Association: e147–e167. doi: 10.2337/dc10-9990 . PMC   2992225 . PMID   21115758.
  8. ↑ Bindels LB, Walter J, Ramer-Tait AE (November 2015). "Resistant starches for the management of metabolic diseases". Current Opinion in Clinical Nutrition and Metabolic Care. 18 (6): 559–565. doi:10.1097/mco.0000000000000223. PMC   4612508 . PMID   26406392.
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  11. ↑ Balentine D (13 December 2016). "Letter announcing decision for a health claim for high-amylose maize starch (containing type-2 resistant starch) and reduced risk of type 2 diabetes mellitus (Docket Number FDA-2015-Q-2352)". www.regulations.gov. U.S. Food and Drug Administration.
  12. ↑ Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, et al. (January 2008). "Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association". Diabetes Care. 31 (Suppl 1): S61–S78. doi: 10.2337/dc08-S061 . PMID   18165339.
  13. ↑ Mozaffarian D, Kamineni A, Carnethon M, Djoussé L, Mukamal KJ, Siscovick D (April 2009). "Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study". Archives of Internal Medicine. 169 (8): 798–807. doi:10.1001/archinternmed.2009.21. PMC   2828342 . PMID   19398692.
  14. ↑ Risérus U, Willett WC, Hu FB (January 2009). "Dietary fats and prevention of type 2 diabetes". Progress in Lipid Research. 48 (1): 44–51. doi:10.1016/j.plipres.2008.10.002. PMC   2654180 . PMID   19032965.
  15. ↑ Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB (November 2005). "Duration of lactation and incidence of type 2 diabetes". JAMA. 294 (20): 2601–2610. doi:10.1001/jama.294.20.2601. PMID   16304074.
  16. ↑ Muley A, Muley P, Shah M (May 2012). "Coffee to reduce risk of type 2 diabetes?: a systematic review". Current Diabetes Reviews. 8 (3): 162–168. doi:10.2174/157339912800564016. PMID   22497654.
  17. 1 2 Sussman JB, Kent DM, Nelson JP, Hayward RA (February 2015). "Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program". BMJ. 350 (feb19 2): h454. doi:10.1136/bmj.h454. PMC   4353279 . PMID   25697494.
  18. ↑ Gerstein HC, Yusuf S, Bosch J, Pogue J, Sheridan P, Dinccag N, et al. (September 2006). "Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial". Lancet. 368 (9541): 1096–1105. doi:10.1016/S0140-6736(06)69420-8. PMID   16997664. S2CID   15150925.
  19. ↑ Kjeldsen SE, Julius S, Mancia G, McInnes GT, Hua T, Weber MA, et al. (July 2006). "Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: the VALUE trial". Journal of Hypertension. 24 (7): 1405–1412. doi:10.1097/01.hjh.0000234122.55895.5b. hdl: 11392/1398436 . PMID   16794491. S2CID   2793427.
  20. ↑ Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, et al. (November 2009). "10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study". Lancet. 374 (9702): 1677–1686. doi:10.1016/S0140-6736(09)61457-4. PMC   3135022 . PMID   19878986.
  21. 1 2 3 Moelands SV, Lucassen PL, Akkermans RP, De Grauw WJ, Van de Laar FA, et al. (Cochrane Metabolic and Endocrine Disorders Group) (December 2018). "Alpha-glucosidase inhibitors for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus". The Cochrane Database of Systematic Reviews. 2018 (12): CD005061. doi:10.1002/14651858.CD005061.pub3. PMC   6517235 . PMID   30592787.
  22. ↑ Wasko MC, Hubert HB, Lingala VB, Elliott JR, Luggen ME, Fries JF, Ward MM (July 2007). "Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis". JAMA. 298 (2): 187–193. doi:10.1001/jama.298.2.187. PMID   17622600.
  23. ↑ Defronzo RA (April 2011). "Bromocriptine: a sympatholytic, d2-dopamine agonist for the treatment of type 2 diabetes". Diabetes Care. 34 (4): 789–794. doi: 10.2337/dc11-0064 . PMC   3064029 . PMID   21447659.
  24. ↑ Mishu MP, Uphoff E, Aslam F, Philip S, Wright J, Tirbhowan N, et al. (February 2021). "Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries". The Cochrane Database of Systematic Reviews. 2021 (2): CD013281. doi:10.1002/14651858.CD013281.pub2. PMC   8092639 . PMID   33591592.
  25. ↑ Dubois H, Bankauskaite V (2005). "Type 2 diabetes programmes in Europe" (PDF). Euro Observer. 7 (2): 5–6. Archived (PDF) from the original on 24 October 2012.
  26. ↑ "NHS Diabetes Prevention Programme (NHS DPP)". NHS England. Retrieved 18 August 2022.
  27. ↑ Marsden AM, Bower P, Howarth E, Soiland-Reyes C, Sutton M, Cotterill S (January 2022). "'Finishing the race' - a cohort study of weight and blood glucose change among the first 36,000 patients in a large-scale diabetes prevention programme". The International Journal of Behavioral Nutrition and Physical Activity. 19 (1): 7. doi: 10.1186/s12966-022-01249-5 . PMC   8793225 . PMID   35081984.
  28. ↑ "Diabetes: putting people at the heart of services". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 26 July 2022. doi:10.3310/nihrevidence_52026. S2CID   251299176.
  29. ↑ "Providers of the Diabetes Prevention Programme need to be more consistent, and offer flexibility and equality of access". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 13 September 2021. doi:10.3310/alert_47416.
  30. ↑ Howarth E, Bower PJ, Kontopantelis E, Soiland-Reyes C, Meacock R, Whittaker W, Cotterill S (December 2020). "'Going the distance': an independent cohort study of engagement and dropout among the first 100 000 referrals into a large-scale diabetes prevention program". BMJ Open Diabetes Research & Care. 8 (2): e001835. doi:10.1136/bmjdrc-2020-001835. PMC   7733095 . PMID   33303493.
  31. ↑ Ravindrarajah R, Sutton M, Reeves D, Cotterill S, Mcmanus E, Meacock R, et al. (February 2023). "Referral to the NHS Diabetes Prevention Programme and conversion from nondiabetic hyperglycaemia to type 2 diabetes mellitus in England: A matched cohort analysis". PLOS Medicine. 20 (2): e1004177. doi: 10.1371/journal.pmed.1004177 . PMC   9970065 . PMID   36848393.
  32. ↑ "How effective are referrals to the NHS Diabetes Prevention Programme?". NIHR Evidence. 4 December 2023. doi:10.3310/nihrevidence_61063. S2CID   265747422.
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