Strong evidence that diabetes can be prevented or delayed is coming from clinical trials — the Diabetes Prevention Program (DPP) and the Finnish Study of Weight Loss — and prospective studies — the Nurses' Health Study and the Health Professionals Follow-up Study.
In the DPP, three interventions were studied: lifestyle modification, metformin and placebo. The incidence of developing type 2 diabetes was reduced in the lifestyle intervention by 58% and in the metformin group by 31% as compared with placebo. The lifestyle intervention was significantly more effective than metformin.
Data from the two prospective studies indicate that a “western” diet combined with lack of physical activity and excess weight dramatically increases the risk of type II diabetes.
We all know diabetes is a very costly illness. Preventing or delaying diabetes can substantially reduce the individual and public health burden. So what can a primary care provider do?
Steps for Diabetes Prevention
- Screen those at risk for developing diabetes before they meet the diagnostic criteria for type 2 diabetes. Some risk criteria are:
- BMI › 25
- Family history of type 2 diabetes
- History of gestational diabetes or at least one child weighing over 9 pounds
- BP › 140/90
- Abnormal lipids
- Watch for patients who meet pre-diabetes criteria of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT):
- Fasting blood sugars in the range of 100 to 126 (IFG)
- 2-hour OGTT with blood sugars in the range of 140 to 199 (IGT)
- Suggest lifestyle intervention for patients with IFG or IGT. Losing 7% of body weight and being active about 150 minutes per week were key factors in the success of the DPP study. Other interesting findings include:
- The DPP found that reinforcement and follow-up are very important for the long-term success in achieving lifestyle modification. Therefore, regardless of whether you facilitate the weight loss and/or activity or you refer, lifestyle change reminders by the PCP at each office visit are very important! 1
- The chances of developing type 2 diabetes increase by 14% for every 2 hours spent watching television vs. pursuing activity.
- Choosing whole grains and whole grain products over highly processed carbohydrates help to prevent type 2 diabetes.
- Smokers are 50 to 90% more likely to develop type 2 diabetes than non-smokers.
For more information on diabetes, try the following resources:
- “Small Steps, Big Rewards” Toolkit for Providers and Patients
- Diabetes Prevention Program
- Harvard School of Public Health Diabetes Information
- National Diabetes Information Clearinghouse
- American Diabetes Association
- Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine. 2002;346:393-403.
- Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. New England Journal of Medicine. 2001;345:790-7.
- van Dam RM, Rimm EB, Willet WC, Stampfer MJ, Hu FB. Dietary patterns and risk for type 2 diabetes mellitus in men. Annals of Internal Medicine. 2002;136:201-9.
- Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willet WC, et al. Walking compared with vigorous physical activity and risk of type 2 diabetes mellitus in women: a prospective study. JAMA. 1999;282:1433-9.
- Ludwig DS. The Glycemic Index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA. 2002;287:2414-23.
- Rimm EB, Manson JE, Stampfer MJ, Colditz GA, Willett WC, Rosner B, et al. Cigarette smoking and the risk of diabetes in women. American Journal of Public Health. 1993;83:211-4.
- Rimm EB, Chan J, Stampfer MJ, Colditz GA, Willett WC. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ. 1995;310:555-9.