Preventing Diabetes: Early Versus Late Preventive Interventions

Abstract

There are a number of arguments in support of early measures for the prevention of type 2 diabetes (T2D), as well as for concepts and strategies at later intervention stages. Diabetes prevention is achievable when implemented in a sustainable manner. Sustainability within a T2D prevention program is more important than the actual point in time or disease process at which prevention activities may start. The quality of intervention, as well as its intensity, should vary with the degree of the identified T2D risk. Nevertheless, preventive interventions should start as early as possible in order to allow a wide variety of relatively low- and moderate-intensity programs. The later the disease risk is identified, the more intensive the intervention should be. Public health interventions for diabetes prevention represent an optimal model for early intervention. Late interventions will be targeted at people who already have significant pathophysiological derangements that can be considered steps leading to the development of T2D. These derangements may be difficult to reverse, but the worsening of dysglycemia may be halted, and thus the clinical onset of T2D can be delayed.

Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study

“…IFG [hepatic insulin resistance and decreased first-phase insulin response], impaired glucose tolerance [skeletal muscle insulin resistance and reduced early-and late-phase insulin response]) may require participation in higher intensity interventions. Interestingly, while high-intensity interventions among participants with impaired glucose tolerance, such as the diabetes prevention programme [18], have been successful in reducing the development of diabetes, high-intensity interventions in isolated IFG have not produced the same response [17,19]. Thus, our findings support the need for further investigation of novel approaches including newer pharmacotherapies such as glucagon-like peptide-1 receptor agonists in individuals with IFG [20].…”

“…However, similar to this analysis, the results were driven by individuals at the lower end of the d i a b e t e s -r i s k s p e c t r u m ( B M I < 3 0 k g / m 2 a n d normoglycaemia) [6], suggesting broader public health interventions may work well for primordial prevention but not as well for those with IFG. As noted by Tuomilehto et al [17], lower-intensity population-level interventions involving multiple stakeholders are well suited for primordial prevention of diabetes, but individuals later in the natural history of glucose dysregulation with significant pathophysiological derangements (i.e. IFG [hepatic insulin resistance and decreased first-phase insulin response], impaired glucose tolerance [skeletal muscle insulin resistance and reduced early-and late-phase insulin response]) may require participation in higher intensity interventions.…”

Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)

“…Individuals at high risk are then encouraged to enroll in a nearby community-based DPP-like program. The later the risk is identified, the more intensive the intervention should be [ 65 ]. The current study used more intensive risk identification based on clinical testing that relied on preexisting obesity treatment referral processes already in place.…”

Prediction of progression from pre‐diabetes to diabetes: Development and validation of a machine learning model

“…Current estimates show that 9% of the population is diagnosed with diabetes and an additional 7.3% has impaired glucose tolerance, of which 5% to 10% are expected to develop diabetes annually . Unsurprisingly, vast efforts are being put into the prevention of diabetes – utilizing approaches that either target the overall population or focus on high‐risk populations in a screen‐and‐treat approach …”