Randomized controlled trials have shown that both lifestyle and pharmacological agents can be of benefit in preventing or slowing progression to overt diabetes. Many other benefits are associated with a healthier lifestyle, including reduced cardiovascular risk and avoidance of obesity-related complications such as cancer.
Diabetes prevention can therefore form a useful component of a wider health improvement strategy. Introduction The twentieth century saw a dramatic rise in the incidence of type 2 diabetes, and a Rising incidence of type 1 diabetes.
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Both forms of diabetes appear to have been rare in the 19th century, and their subsequent increase in genetically stable populations must therefore be due to non-genetic factors. This view is supported by the observation that an increasing incidence of type 2 diabetes first began in industrialized and more affluent countries and spread subsequently to other parts of the world as these adopted a "western" lifestyle - so-called "coca-colonization". Type 2 diabetes is strongly associated with obesity, itself associated with ready access to food and a more indolent lifestyle.
Conversely, periods of famine have repeatedly been shown to reduce the incidence of diabetes. One basic question in diabetes prevention relates to what you are trying to achieve.
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Is avoidance of hyperglycaemia, obesity, the metabolic syndrome or cardiovascular risk the major objective? There is considerable overlap between these goals, but there are also important differences in emphasis.
For example, "isolated" obesity or hyperglycaemia may be considered relatively harmless conditions when present in isolation from other components of the metabolic syndrome, whereas the greatest reduction in morbidity and mortality is to be expected from intervention in those with multiple risk factors. Since lifestyle can be modified, most cases of type 2 diabetes are in theory preventable.
Diet and exercise form the mainstay of such strategies, but a number of pharmacological interventions have also been proposed and tested.
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This experimental work goes hand in hand with investigations which set out to understand the pathways and mechanisms by which diabetes develops. Primary Prevention aims to prevent a condition which does not as yet exist e. Mayor Bloomberg's unsuccessful attempt to limit the size of soft drinks containers on sale in New York in the attempt to tackle obesity is one example.
Avoidance of obesity is the major target of primary prevention, and increased exercise or restricted calorie intake thus form the mainstay of primary prevention of diabetes. Secondary Prevention is based on the earliest possible identification of the disease for early evidence-based intervention. In diabetes, this identification is based on evidence of disordered glucose metabolism, which may be assessed by the oral glucose tolerance test or measurement of fasting glucose or HbA1c.
Prevention of Type 2 Diabetes: Evidence and Strategies | Journal of Clinical Outcomes Management
Secondary prevention is typically offered via a two-step process in which population screening is followed by intervention in those with dysglycaemia. Tertiary Prevention is offered to those who already have the condition in its early stages when it is potentially reversible. This is most effectively achieved by weight loss, whether achieved by diet, drugs or bariatric surgery. The programme focused on improving diet quality, reducing portion size, increasing physical activity levels, as well as boosting confidence in the ability to change and a commitment to the process.
Analysis of the results showed that the initiative led to an average fall in HbA1c of 2.
The average weight loss amounted to 10 kg at the 12 month time point a reduction in BMI of 3. Use clinical judgement on whether and when to offer metformin to support lifestyle change for people whose HbA1c or fasting plasma glucose blood test results have deteriorated, if:. Metformin does not have UK marketing authorisation for this indication and so informed consent should be obtained and documented. Continue to offer advice on diet and physical activity along with support to achieve their lifestyle and weight-loss goals. Check the person's renal function before starting treatment and then twice-yearly more often if they are older or if deterioration is suspected.
Start with a low dose eg, mg once daily and then increase gradually as tolerated to mg daily.
If the person is intolerant of standard metformin then consider using modified-release metformin. Prescribe metformin initially for months. Monitor the person's fasting plasma glucose or HbA1c levels at three-monthly intervals and stop the drug if no effect is seen. Keep an up-to-date register of people's level of risk.
Prevention of type 2 diabetes
Introduce a recall system to contact and invite people for regular review. Offer a reassessment based on the level of risk. Use clinical judgement to determine when someone might need to be reassessed more frequently, based on their combination of risk factors eg, BMI, relevant illnesses or conditions, ethnicity and age. For people at low risk low or intermediate risk score : offer to reassess at least every five years. Use a validated risk assessment tool. For people at moderate risk a high risk score but with a fasting plasma glucose less than 5.
For people at high risk a high risk score and fasting plasma glucose of 5. A review on behalf of Public Health England confirmed previous research, demonstrating that diabetes prevention programmes can significantly reduce the progression to type 2 diabetes and lead to reductions in weight and glucose compared with usual care [ 7 ]. Health and well-being boards and public health commissioners, working with clinical commissioning groups, should develop a comprehensive and co-ordinated type 2 diabetes prevention commissioning plan, based on the data collated.
This should include:. Did you find this information useful? We'd love to send you our articles and latest news by email, giving you the best opportunity to stay up to date with expert written health and lifestyle content. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service.
It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. All problems adverse events related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it.
They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.