Prevention of type 2 diabetes: what is the right target population?

ABSTRACT

Introduction: Prevention of type 2 diabetes (T2D) is important to reduce suffering and health care costs. A precursor to T2D is impaired glucose regulation (IGR), a condition of elevated plasma glucose that is associated with insulin resistance and increased risk of cardiovascular disease. Prevention of T2D is determined by preservation of pancreatic β cell function which can be achieved by the use of anti-hyperglycemic medications or intensive lifestyle interventions (ILIs) to modify dietary and physical activity habits that induce modest weight loss (≥5%). Both interventions have beneficial effects on normal glucose regulation (NGR), but ILI is preferred due to its safety, efficacy, and cost.

Areas covered: Traditional approaches to the prevention of T2D have used a variety of screening methods to identify those who are at high risk for developing T2D (prediabetes). People designated with prediabetes are then treated with ILI. An alternative approach for preventing T2D is to offer ILI to all overweight/obese adults who volunteer for weight loss treatment.

Expert commentary: This new alternative has several potential advantages: more rapid recruitment of participants with lower burden of care and early, aggressive treatment of potential β cell dysfunction. Cost-effectiveness studies of this alternative approach are needed.

KEYWORDS:

• Intensive lifestyle interventions
• obesity
• overweight
• prediabetes
• prevention
• screening
• type 2 diabetes

Declaration of interest

DA Williamson is a member of the Clinical Advisory Board and consultant for Real Appeal, Inc. He is retired, formally John McIlhenny Professor of Nutrition at Pennington Biomedical Research Center where his research was sponsored by the National Institutes of Health, Department of Defense, US Department of Agriculture, and numerous corporations and companies. The Pennington Center is one component of the Louisiana State University System and is located in Baton Rouge, LA USA. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Funding

This paper is not funded.