With diabetes increasing at a rapid rate, ways to prevent it are becoming increasingly important. A large study has been reported that shows the effects of lifestyle changes and the drug metformin on the occurrence of diabetes in people at high risk. Here's a summary of the findings.

The massive rise in type 2 diabetes in recent years, the serious health risks associated with the condition, and the fact that several risk factors for the disease can be modified, have created great interest in whether diabetes can be prevented.

Most programs aiming to prevent diabetes have focused on high-risk groups, particularly people whose blood glucose is already moderately raised. Recent studies have shown that lifestyle advice can be extremely effective at reducing diabetes risk in these groups.

The largest of these studies was the Diabetes Prevention Program (DPP) carried out in the USA. This study involved 3,234 overweight people with impaired glucose tolerance (IGT). IGT is an intermediate state between normal blood glucose control and type 2 diabetes, sometimes referred to as 'pre-diabetes'. IGT carries a high risk of progressing to type 2 diabetes. In addition, almost half the DPP participants were from an ethnic group at increased risk of diabetes.

The DPP subjects were divided into three groups, who received:

• general lifestyle advice once a year, plus metformin (a drug that lowers blood sugar), or
• general lifestyle advice once a year, plus a placebo (dummy pill), or
• intensive lifestyle advice (16 sessions over 24 weeks) encouraging weight loss and increased physical activity.

The subjects were followed up for an average of 2.8 years. Compared to the placebo group, the incidence of diabetes was 58% lower in the group that had received intensive lifestyle advice, and 31% lower in the group who had received metformin. This was an extremely encouraging result.

Although frequent lifestyle advice, given by a trained health professional, reduces the number of people at high risk who go on to develop diabetes, even the most effective lifestyle program will not work for everyone. As diabetes carries such serious health risks, there is a growing feeling that people at high risk of diabetes who do not respond to lifestyle advice should be given drugs to reduce their risk. A number of large clinical trials are in progress to investigate whether drugs that improve insulin secretion, or improve the body's sensitivity to insulin, can prevent - or at least delay - the development of diabetes in people at high risk. It is believed that delaying diabetes will also delay or prevent diseases related to diabetes, such as cardiovascular diseases and kidney damage.

Source

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.  Diabetes Prevention Program Research Group., N Engl J Med, 2002, pp. 393--403

Links

• Test your risk for Diabetes Type 2
• Pathways - the Novartis Journal, Highlights Diabetes
• Working with the International Diabetes Federation. Novartis' Focus on Diabetes

Syndrome X, the Silent Killer: The New Heart Disease Risk by Gerald M. Reaven et al.