Prevention of Diabetes in Family Medicine

Abstract

Conflict of interest: none declared.IntroductionThe incidence of diabetes type 2 (diabetes mellitus type 2 – DM 2) is rapidly increasing worldwide. Physical inactivity and obesity are the major determinants of the disease. Primary prevention of DM 2 entails health monitoring of people at risk category. People with impaired glycemic control are at high risk for development of DM 2 and enter the intensive supervision program for primary and secondary prevention.Objective of the researchTo evaluate the impact of metformin and lifestyle modification on glycemia and obesity in patients with prediabetes.Patients and MethodsThe study was conducted on three groups of 20 patients each (total of 60 patients) aged from 45 to 80, with an abnormal glycoregulation and prediabetes. The study did not include patients who already met the diagnostic criteria for the diagnosis of diabetes. During the study period of 6 months, one group was extensively educated on changing lifestyle (healthy nutrition and increased physical activity), the second group was treated with 500 mg metformin twice a day, while the control group was advised about diet and physical activities but different from the first two groups. At beginning of the study, all patients were measured initial levels of blood glucose, HbA1C, BMI (Body Mass Index), body weight and height and waist size. Also the same measurements were taken at the end of the conducted research, 6 months later. For the assessment of diabetes control was conducted fasting plasma glucose (FPG) test and 2 hours after a glucose load, and HbA1C.ResultsAt the beginning of the study the average HbA1C (%) values in three different groups according to the type of intervention (lifestyle changes, metformin, control group) were as follows: (6.4 ± 0.5 mmol / l), (6.5 ± 1.2 mmol / l), (6.7 ± 0.5 mmol / l). At the end of the research, the average HbA1C values were: 6.2 ± 0.3 mmol / l, 6.33 ± 0.5 mmol / l and 6.7 ± 1.4 mmol / l. In the group of patients who received intensive training on changing lifestyle or group that was treated with metformin, the average reduction in blood glucose and HbA1C remained within the reference range and there were no criteria for the diagnosis of diabetes. Unlike the control group, a group that was well educated on changing habits decreased average body weight by 4.25 kg, BMI by 1.3 and waist size by 2.5 cm. Metformin therapy led to a reduction in the average weight of 3.83 kg, BMI of 1.33 and 3.27 for waist size. Changing lifestyle (healthy diet and increased physical activity) has led to a reduction in total body weight in 60% of patients, BMI in 65% of patients, whereas metformin therapy led to a reduction of the total body weight in 50%, BMI in 45% of patients. In the control group, the overall reduction in body weight was observed in 25%, and BMI in 15% of patients.ConclusionModification of lifestyle, such as diet and increased physical activity or use of metformin may improve glycemic regulation, reduce obesity and prevent or delay the onset of developing DM 2.

Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force

“…Of 11,317 citations (plus articles from other existing systematic reviews and domain experts), 53 studies described 66 D&PA programs in 104 articles (6–11;22–119). One additional study was excluded for limited quality of execution (with six major limitations) (120). The included studies described 26 randomized and 4 nonrandomized comparisons of D&PA programs versus usual care, 12 randomized and 1 nonrandomized comparisons of two or more D&PA programs (3 of which also had usual care arms), and 13 single group studies of D&PA programs.…”

Value of Lifestyle Intervention to Prevent Diabetes and Sequelae

“…5,48 Evidence suggests that lifestyle interventions implemented over a short period can still have longlasting, beneficial, carryover effects on type 2 diabetes incidence. 49 Long-term health benefits are considered the true measure of diabetes screening program cost effectiveness.…”

Effect of Oral Supplementation With Curcumin on Insulin Sensitivity in Subjects With Prediabetes

“…It has been advice, in specific circumstances, to grant a pharmacological regimen. Studies sustain that the execution of a restrictive plan of exercise and food quality reduces the risk of DM2 between 40 al 70%, regardless of age, sex and racial condition (6). Pharmacotherapy (metformin and pioglitazone, mainly) is reserved for the treatment of patients with prediabetes who meet the following conditions: Body mass index > 35 kg/m 2 , Women with previous gestational diabetes and patients under 60 years of age that meet any of the previous criteria (7).…”