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The Prevention or Delay of Type 2 Diabetes

Reprinted with permission from Diabetes Care 25:742–749, 2002

The first 300 words of the full text of this article appear below.

Diabetes is one of the most costly and burdensome chronic diseases of our time and is a condition that is increasing in epidemic proportions in the U.S. and throughout the world.1 The complications resulting from the disease are a significant cause of morbidity and mortality and are associated with the damage or failure of various organs such as the eyes, kidneys, and nerves. Individuals with type 2 diabetes are also at a significantly higher risk for coronary heart disease, peripheral vascular disease, and stroke, and they have a greater likelihood of having hypertension, dyslipidemia, and obesity.2–6

There is also growing evidence that at glucose levels above normal but below the threshold diagnostic for diabetes, there is a substantially increased risk of cardiovascular disease (CVD) and death.5,7–10 In these individuals, CVD risk factors are also more prevalent,5–7,9,11–14 which further increases the risk but is not sufficient to totally explain it.

In contrast to the clear benefit of glucose lowering to prevent or retard the progression of microvascular complications associated with diabetes,15–18,21 it is less clear whether the high rate of CVD in people with impaired glucose homeostasis, i.e., those with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or diabetes, is caused by elevated blood glucose levels or will respond to treatments that lower blood glucose. Epidemiological studies have shown a clear relationship,19,20 whereas intervention trials in people with diabetes suggest, but have not demonstrated, a clear benefit of glycemic control.15,16,21,22 Additionally, there are no studies that have investigated a benefit of glucose lowering on macrovascular disease in subjects with only IFG or IGT but not diabetes.

Although . . . [Full Text of this Article]

QUESTION 1: Should we attempt to prevent diabetes?

QUESTION 2: Who are potential candidates for screening and intervention?

Choice of screening test
Age considerations and screening frequency
QUESTION 3: How should diabetes prevention be performed?

Lifestyle modification
Pharmacological interventions
Lifestyle or medication?
QUESTION 4: How do strategies to prevent diabetes differ from those to treat diabetes?

QUESTION 5: What additional research is needed?

Conclusions

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