Prevention of type 2 diabetes

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.

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. The American Diabetes Association (ADA) recommends maintaining a healthy weight, getting at least 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), 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 and may reduce the risk of type 2 diabetes. 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.

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

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".

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.

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.

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.

Medications

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

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). 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. 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.

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. Dopamine receptor agonists are also known to improve glycemic control, reduce insulin resistance and help controlling body weight.

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.

Programmes

Several countries have established more and less successful national programmes to improve prevention and treatment of diabetes. In the UK, the NHS's national diabetes prevention programme, Healthier You, offers personalised face-to-face and digital services. 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. At the same time, only 1 in 5 people complete the whole 9-month programme. A study of 18,470 people who had been referred to the programme found that they had a 20% reduced risk of developing diabetes.

References

References

1. (December 2008). "Lifestyle interventions reduced the long-term risk of diabetes in adults with impaired glucose tolerance". Evidence-Based Medicine.
2. (September 2021). "Tackling risk factors for type 2 diabetes in adolescents: PRE-STARt study in Euskadi". Anales de Pediatría.
3. (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.
4. (November 2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study". Lancet.
5. (February 2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin". The New England Journal of Medicine.
6. (November 2009). "10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study". Lancet.
7. (December 2010). "Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement". American Diabetes Association.
8. (November 2015). "Resistant starches for the management of metabolic diseases". Current Opinion in Clinical Nutrition and Metabolic Care.
9. (March 2015). "Role of resistant starch in improving gut health, adiposity, and insulin resistance". Advances in Nutrition.
10. (January 2015). "Dietary substitutions for refined carbohydrate that show promise for reducing risk of type 2 diabetes in men and women". The Journal of Nutrition.
11. (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)". U.S. Food and Drug Administration.
12. (January 2008). "Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association". Diabetes Care.
13. (April 2009). "Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study". Archives of Internal Medicine.
14. (January 2009). "Dietary fats and prevention of type 2 diabetes". Progress in Lipid Research.
15. (November 2005). "Duration of lactation and incidence of type 2 diabetes". JAMA.
16. (May 2012). "Coffee to reduce risk of type 2 diabetes?: a systematic review". Current Diabetes Reviews.
17. (February 2015). "Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program". BMJ.
18. (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.
19. (July 2006). "Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: the VALUE trial". Journal of Hypertension.
20. (November 2009). "10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study". Lancet.
21. (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.
22. (July 2007). "Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis". JAMA.
23. (April 2011). "Bromocriptine: a sympatholytic, d2-dopamine agonist for the treatment of type 2 diabetes". Diabetes Care.
24. (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.
25. (2005). "Type 2 diabetes programmes in Europe". Euro Observer.
26. "NHS Diabetes Prevention Programme (NDPP)".
27. (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.
28. (2022-07-26). "Diabetes: putting people at the heart of services". National Institute for Health and Care Research.
29. (2021-09-13). "Providers of the Diabetes Prevention Programme need to be more consistent, and offer flexibility and equality of access". National Institute for Health and Care Research.
30. (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.
31. (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.
32. (4 December 2023). "How effective are referrals to the NHS Diabetes Prevention Programme?". NIHR Evidence.