Type 2 diabetes is a serious metabolic disease that has been clinically proven to be preventable in many cases. Prevention starts with identifying at-risk individuals. Once identified, both drugs and lifestyle changes can prevent the onset of diabetes in these patients.
Identifying Patients at Risk for Diabetes
The Diabetes Prevention Program, a large, multi-center study, examined strategies to identify at-risk individuals who might benefit from interventions to prevent diabetes. It found that the fasting capillary glucose test was an effective screening tool (DPPRG 2005). Fasting capillary glucose tests blood at peripheral locations such as the fingertips after the patient has fasted overnight.
Patient perception is key to gaining participation from at-risk patients. One study (Harwell et al. 2001) was a patient survey of people with at least one risk factor for type 2 diabetes (age over 44). 80% of respondents had at least one additional risk factor, but 71% of the respondents did not consider themselves at risk at all. Those with the largest number of risk factors were least likely to consider diabetes to be a preventable disease. This study suggests that the first step in early diabetes prevention is patient education.
Methods of Early Diabetes Prevention
Diabetes prevention has been widely studied, and two major approaches have been found effective: drug intervention and lifestyle changes. One of the most significant and wide-ranging clinical studies was the Diabetes Prevention Program study, which found that lifestyle intervention was the more effective of the two methods (DPPRG 2002). The only drug this study examined was metformin. Drugs of another class, the thiazolidinedione drugs (TZDs), have also been found to prevent type 2 diabetes, although they are expensive (Davidson 2007).
Lifestyle-Based Diabetes Preventions
The lifestyle interventions that can prevent diabetes fall into two categories, aimed at reducing blood sugar and normalizing obesity: nutritional changes and exercise.
One nutritional change is to begin monitoring carbohydrate input. The American Diabetes Association (ADA) recommends consuming 45-60 grams of carbohydrate per meal, along with balanced amounts of protein and fat. A food’s glycemic index (GI) is an important consideration. The glycemic index is a measure of how much that food raises blood glucose; high GI foods raise it a great deal and low GI foods raise it less. According to the ADA, low to medium GI foods are the best choices for a diabetes-prevention diet.
Exercise includes any type of physical activity. It may mean formal, structured activity such as going to the gym or practicing martial arts, or it may be unstructured, such as playing with children or doing housework. Exercise should be incorporated into one’s daily activities to obtain a protective effect against type 2 diabetes.
- American Diabetes Association (ADA), n.d. “How to Prevent or Delay Diabetes.” ADA website.
- Davidson, M. B., 2007. “Clinical Implications of the DREAM Study: should prediabetes be treated to prevent diabetes or heart disease?” Editorial in Diabetes Care, February 2007 issue.
- The Diabetes Prevention Program Research Group (DPPRG), 2002. “Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin.” New England Journal of Medicine 6(346):393-403.
- DPPRG, 2005. “Strategies to Identify Adults at High Risk for Type 2 Diabetes.” Diabetes Care 28:138-144.
- Harwell, T. S.; N. Dettori, B. N. Flook, L. Priest, D. F. Williamson, S. D. Helgerson, & D. Gohdes, 2001. “Preventing Type 2 Diabetes: Perceptions about risk and prevention in a population-based sample of adults ≥45 years of age.” Diabetes Care 24:2007-8.