Primary Prevention of Diabetes Mellitus

Abstract

Diabetes mellitus is one of the chronic noncommunicable diseases that have increased markedly in this century. The discovery of insulin and other drugs for lowering hyperglycemia have certainly reduced mortality from acute complications of diabetes and improved the quality of life of many diabetic patients. Recent advances in research into the etiology and natural history of diabetes have increased our knowledge about different types of diabetes to such an extent that primary prevention of diabetes mellitus is becoming a reality. Until now, few studies have attempted to test measures for primary prevention of diabetes. Therefore, the data supporting the possibility for primary prevention are largely indirect and need to be tested in preventive trials or in community-based prevention programs. We believe, however, that the time is right to start action in populations in which the prevalence of diabetes is known to have clearly increased recently. We summarize the evidence that can be used as the scientific basis of primary prevention of diabetes mellitus.

Prevention of Type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland

“…The prevention of Type II diabetes has become a major issue both scientifically and from a public health point of view [11]. Type II diabetes has a strong genetic component and hyperglycaemia usually worsens with time [11,12].…”

“…The prevention of Type II diabetes has become a major issue both scientifically and from a public health point of view [11]. Type II diabetes has a strong genetic component and hyperglycaemia usually worsens with time [11,12]. When genetically predisposed subjects become more insulin resistant, for instance due to obesity and physical inactivity, they could develop postprandial hyperglycaemia or impaired glucose tolerance (IGT) [13,14].…”

Prevention of Diabetes Mellitus in Subjects with Impaired Glucose Tolerance in the Finnish Diabetes Prevention Study

“…Although the genetic basis of T2DM diabetes has still to be identified, unequivocal evidence shows that obesity and physical inactivity are the main environmental determinants of the disease (2)(3)(4)(5)(6)(7)(8)(9). Subjects with impaired glucose tolerance (IGT) have an increased risk for T2DM and cardiovascular complications of hyperglycemia (10), and therefore form an important high-risk group for actions aimed at preventing diabetes (2)(3)(4)(5).…”

“…Subjects with impaired glucose tolerance (IGT) have an increased risk for T2DM and cardiovascular complications of hyperglycemia (10), and therefore form an important high-risk group for actions aimed at preventing diabetes (2)(3)(4)(5). Approximately 10 to 15% of the adult populations in developed countries have IGT (2)(3)(4)(5). Chronic hyperglycemia is a necessary condition for microvascular complications such as nephropathy and retinopathy, but it has been recently shown that hyperglycemia is also an independent risk factor for cardiovascular disease (CVD).…”

“…Chronic hyperglycemia is a necessary condition for microvascular complications such as nephropathy and retinopathy, but it has been recently shown that hyperglycemia is also an independent risk factor for cardiovascular disease (CVD). Once clinical symptoms of diabetes occur, the natural history of the process leading to T2DM has progressed far, and approximately 50% of the function of the pancreatic B cells has already been lost (2)(3)(4)(5). This process is likely to progress further, even when intensive anti-diabetic treatment is applied.…”