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]
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]
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]
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]
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]
Insulin resistance (IR) is a pathological condition in which cells either fail to respond normally to the hormone insulin or downregulate insulin receptors in response to hyperinsulinemia.
Hyperglycemia is a condition in which an excessive amount of glucose 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.
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. Symptoms may also include increased hunger, having a sensation of pins and needles, and sores (wounds) that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.
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. It is sometimes used as an off-label adjunct to lessen the risk of metabolic syndrome in people who take antipsychotics. Metformin is not associated with weight gain and is taken by mouth.
Drugs used in diabetes treat diabetes mellitus by decreasing the glucose level in the blood. With the exception of insulin, most GLP receptor agonists, and pramlintide, all are administered orally and are thus also called oral hypoglycemic agents or oral antihyperglycemic agents. There are different classes of hypoglycemic drugs, and their selection depends on the nature of diabetes, age, and situation of the person, as well as other factors.
Pioglitazone, sold under the brand name Actos among others, is an anti-diabetic medication used to treat type 2 diabetes. It may be used with metformin, a sulfonylurea, or insulin. Use is recommended together with exercise and diet. It is not recommended in type 1 diabetes. It is taken by mouth.
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, it increases the risk of pre-eclampsia, depression, and of needing a Caesarean section. Babies born to mothers 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.
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.
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.
The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentrations of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity-onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes.
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.
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 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.
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.
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.
Complications of diabetes are secondary diseases that are a result of elevated blood glucose levels that occur in diabetic patients. These complications can be divided into two types: acute and chronic. Acute complications are complications that develop rapidly and can be exemplified as diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), lactic acidosis (LA), and hypoglycemia. Chronic complications develop over time and are generally classified in two categories: microvascular and macrovascular. Microvascular complications include neuropathy, nephropathy, and retinopathy; while cardiovascular disease, stroke, and peripheral vascular disease are included in the macrovascular complications.
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 not recommended for type 1 diabetes. It is taken by mouth.
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. Untreated or poorly treated diabetes accounts for approximately 1.5 million deaths every year.
Bexagliflozin, sold under the brand name Brenzavvy, is an antidiabetic medication used to improve glycemic control in adults with type 2 diabetes as an adjunct to diet and exercise. It is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that is taken by mouth.