PREVENTION OF DIABETES:

        Article:   Prevention of Type 2 Diabetes is Beneficial. Individual at Pre-Diabetic States are at high risk for Coronary Vascular Disease (CVD). Recently six well controlled trial reports available. Prevention was attempted thru life-style changes and/or, pharmacological means.

          Diabetes is an important Health Problem. The Natural History is well understood. Simple and reliable test to detect pre-disease state is present. The prevention program is safe, effective and reliable. Cost of intervention not burdensome. This justifies the prevention program.

         In the Da Qing Study, all patients with IGT were grouped. The first group was treated with diet only, second group with exercise only and the third group with both. After 6 years of 6 monthly follow up the risk of developing diabetes reduced by 31%, 46% and 42% respectively in these three groups.

        The Finnish Study was performed with 522 obese (BMI 31kg/sq.M), middle aged subjects all with impaired glucose tolerance. Here the control group received brief diet and exercise instructions while intervention group received intensive individualized instruction on diet, weight reduction, and physical activity. Treatment goals for this group included diet modification where fat intake consisted of less than 30% of total calories, saturated fat intake less than 10% of total Calories, and fiber intake comprised about 15 g/1000 kcal. Weekly physical activity of more than 150 minutes was aimed along with weight reduction of more than 5 %. No Untoward effects were observed. Results of the study showed that the incidence of diabetes was lowered by 58% (Relative Reduction) in the intervention Group, compared to the Control Group after an average follow-up period of 3.2 years.

         Diabetes prevention program (DPP) carried on a study with 3234 obese (mean BMI 34 kg/sq. m) subjects with mean age of 51 years. All subjects had impaired fasting glucose and impaired glucose tolerance. 45% subjects were from the minority group (American Asian/ Hispanic), and 20% subjects > 60 years of age. Subjects were divided into three groups - First group received counseling about lifestyle modification i.e. intensive nutrition and exercise, the second group received metformin, standard diet and exercise, while the third group received placebo and standard diet & exercise. After an average follow-up period of 2.8 (1.8 - 4.6) years, the study showed that the absolute incidence of diabetes in the lifestyle group was 4.8%, (58% relative reduction), metformin group 7.8% (31% relative reduction) and in the placebo group absolute incidence was 11%. 50% of lifestyle group achieved weight reduction of 7% with exercise 150 min per week.

          Stop - NIDDM trial with 1429 obese (average BMI 31 kg/sq. m) participants, with an impaired glucose tolerance, and an average age of 55 years. The study was performed by double blind trial with acarbose v/s Placebo. Mean Follow-up period was 3.3 years. The study was based on OGTT after 75 g. glucose. The study showed an absolute risk reduction of 9% ; relative risk reduction of 36% in the acarbose group compared to Placebo.The effect of Acarbose was consistent in all age groups, BMI values and in both sexes.

          In the Tripod study, 235 Hispanic women with history of gestational diabetes mellitus were randomized to receive Troglitazone or placebo. After Median follow-up period of 30 months to see incidence of Type 2 diabetes, in the group receiving Troglitazone  the annual incidence of Type 2 diabetes was 5.4%. In the placebo arm the annual incidence of Type 2 diabetes was 12.3%. Thus Troglitazone therapy was associated with 56% relative reduction of progression of diabetes.

          XENical in prevention of Diabetes and Obese Subjects Xendos with BMI > 30 Kg/sq.M  Orlistat  and lifestyle changes caused risk reduction of 45% in impaired glucose tolerance group only.

         Thus the ideal candidates for Intervention and Screening are those with age above 30 - 40 years, with Positive Family History, those who are overweight (BMI 23 /sq. m for Asian American), with Indian / Hispanic/ Pacific Islander ethnicity. Best means of prevention consisted of lifestyle modification, weight loss, diet regulation, exercise 30 min /day and measures with known cardiovascular benefit.

               There is substantial evidence that Type 2 diabetes can be prevented or delayed. Individuals at high risk of developing diabetes can be identified. Diabetes prevention strategies by weight loss and increased physical activity are likely to have additional health benefits.

References:  
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Prevention of non-insulin-dependent diabetes mellitus with physical activity.
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