Guiding diabetes screening and prevention: rationale, recommendations and remaining challenges

Abstract

Advances made in diabetes management are not sufficient to reduce morbidity, mortality and cost without making prevention efforts at various levels imperative for substantial impact. Research has demonstrated the efficacy of lifestyle intervention and medications in preventing type 2 diabetes among diverse high-risk groups commonly identified with oral glucose tolerance testing. Efficacy, sustainability and safety data are most comprehensive for lifestyle and metformin, with other medications also demonstrating efficacy and potential in the pharmacoprevention of diabetes. Subsequent implementation studies have demonstrated feasibility of lifestyle intervention programs at health centers, communities, and at local and national government levels. Challenges remain in widespread translation and reaching and engaging at-risk individuals and populations.

Keywords:

• diabetes
• diabetes prevention
• diabetes prevention program
• lifestyle
• obesity
• pharmacoprevention
• prevention

Financial & competing interests disclosure

VR Aroda received research grants (multi-center trial conduct) from Amylin, Astra Zeneca, BMS, Novo Nordisk, Sanofi, Halozyme, GI Dynamics, Boehringer Ingelheim, Hanmi, Intarcia, Takeda and Eisai. VR Aroda has been a consultant for Janssen, Novo Nordisk and Sanofi, and all agreements were through the employers’ institution (no direct financial benefit). A Getaneh received research grants (multi-center trial conduct) from Amylin, Astra Zeneca, BMS, Novo Nordisk, Sanofi, Halozyme, GI Dynamics, Boehringer Ingelheim, Hanmi and Eisai. The authors have 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.

Key issues

• Although advances in diabetes management have reduced the incidence of diabetes-related complications, prevalence of prediabetes and diabetes continues to increase worldwide.

• Diabetes is an important health problem, with a recognizable preclinical stage, and clinically accurate tests to detect prediabetes and early diabetes.

• Diabetes can be prevented or delayed in populations at risk. Lifestyle intervention for the prevention of diabetes has been shown to be effective in high-risk individuals from multiple ethnic populations, in both genders and in different age groups.

• Lifestyle interventions for the prevention or delay of diabetes in high-risk populations include efforts to lose 7% or more of one’s body weight through dietary changes and increase in moderate physical activity up to 150 min per week.

• Multiple agents have been studied in pharmacoprevention. Metformin has been the longest studied, showing long-term benefit in diabetes prevention or delay.

• Current recommendations include screening individuals who are overweight with any additional risk factor for type 2 diabetes or to begin screening at age 45 years in those without risk. Interventions similar to those in the Diabetes Prevention Program for those at risk are recommended.

• Long-term follow-up of diabetes prevention studies demonstrate the long-term benefit and cost–effectiveness of diabetes prevention.

• A multi-level approach to diabetes prevention, involving individuals, health care providers and communities, is required to facilitate translation.