Guidelines for The Prevention of Diabetes

Ibrahim S. Salti MD, PhD, FRCPC, FACP
Professor of Medicine
Head of Division of Endocrinology & Metabolism, AUBMC

A question that is often asked by patients is whether there are scientifically based measures that can effectively reduce the appearance of diabetes. The first answer is that when it comes to type 1 diabetes, all measures aimed to prevent its appearance have proven to be futile and unsuccessful. This disappointing conclusion does not come as a surprise since in general it is very difficult to predict the appearance of type 1 diabetes.

On the other hand, there are several measures that have proven to be effective at least partially successful in preventing the appearance of type 2 diabetes. These are particularly more successful in those individuals who are at risk of becoming diabetic and which include the following categories:

  1. Subjects above the age of 40 years
  2. Patients with hypertension
  3. Patients with hyperlipidaemia
  4. Women with history of diabetes in pregnancy (Gestational Diabetes)
  5. Patients with obesity, particularly abdominal obesity
  6. Patients with pre-diabetes (Impaired fasting glucose or impaired glucose tolerance)
  7. Subjects with a positive family history of diabetes in parents or siblings

The following measures have been proven to be effective in reducing the new onset of diabetes:

Life-Style Modification

This includes a weight reducing diet coupled with regular exercise (e.g. brisk walking for 30 minutes at least five times per week). In several studies, these measures have proven to be successful in reducing the likelihood of appearance of diabetes. This was true even with modest weight loss (an average of 3-4 kg/2 yrs).

Pharmacologic Therapy

Some anti-diabetic drugs have been shown to help in reducing the onset of diabetes. These include:

  1. Metformin which can delay the onset of type 2 diabetes in patients with pre-diabetes especially
in younger obese patients and particularly in women with history of gestational diabetes. However, metformin is less effective than diet and exercise.
  2. Pioglitazone was shown in one study to be effective in reducing the onset of new type 2 diabetes in subjects at risk of the disease. However, the disadvantage was a weight gain of about 4 kg.
  3. Alpha-glucosidase Inhibitors e.g. Acarbose which in one study reduced the risk of diabetes. However this
was not confirmed in another study. Moreover, the main disadvantage was the high incidence of gastrointestinal side-effects.
  4. Lipase inhibitors (Orlistat) also reduce the progression to diabetes in obese patients. However, its use is limited by gastro-intestinal side effects.

In addition, in those patients with hypertension, the use of anti-hypertensives, which are inhibitors of Angiotensin II (ACE-inhibitors and Angiotensin Receptor Inhibitors) significantly reduced by 25% the incidence of newly diagnosed diabetes.

Bariatric Surgery

In diabetic obese patients, bariatric surgery results in large improvements on blood glucose control. In obese individuals without diabetes, bariatric surgery was effective in reducing the appearance of new onset diabetes. The potential mechanisms include a reduction in caloric intake and weight loss.

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