We Can Change the Natural History of Type 2 Diabetes

Abstract

As diabetes develops, we currently waste the first ∼10 years of the natural history. If we found prediabetes and early diabetes when they first presented and treated them more effectively, we could prevent or delay the progression of hyperglycemia and the development of complications. Evidence for this comes from trials where lifestyle change and/or glucose-lowering medications decreased progression from prediabetes to diabetes. After withdrawal of these interventions, there was no “catch-up”—cumulative development of diabetes in the previously treated groups remained less than in control subjects. Moreover, achieving normal glucose levels even transiently during the trials was associated with a substantial reduction in subsequent development of diabetes. These findings indicate that we can change the natural history through routine screening to find prediabetes and early diabetes, combined with management aimed to keep glucose levels as close to normal as possible, without hypoglycemia. We should also test the hypothesis with a randomized controlled trial.

Diabetes: Leveraging the Tipping Point of the Diabetes Pandemic

“…Modification of lifestyle factors is therefore an important strategy for reducing both the incidence of type 2 diabetes and subsequent complications. Several randomized clinical trials such as the Chinese Da Qing IGT and Diabetes Study, the Finnish Diabetes Prevention Study (DPS), and the U.S. Diabetes Prevention Program (DPP) have demonstrated that effective lifestyle intervention strategies (dietary modification and enhanced physical activity) can prevent or delay the progression to type 2 diabetes among high-risk adults with impaired glucose tolerance (15). Studies including the Da Qing IGT and Diabetes Study provided evidence suggesting that for subjects with impaired glucose tolerance, the more insulin resistance there is, the less benefit there is in preventing progression to diabetes with lifestyle change alone despite significant benefits in insulin sensitivity with lifestyle modification (16).…”

Effect of antihyperglycemic drug monotherapy to prevent the progression of mild hyperglycemia in early type 2 diabetic patients: the Japan Early Diabetes Intervention Study (JEDIS)

“…a-GIs seem to be somewhat weaker than metformin and DPP-4i to suppress FPG. The latter two drugs, metformin and DPP-4i, seem to be more preferable than the others, but it is necessary to check for a longer period to confirm their true efficacy also on the fate of T2DM [56]. It is possible that a-GI primarily inhibits post-prandial blood glucose and their effect on FPG may be rather indirect.…”

Prevention of type 2 diabetes with the Chinese herbal medicine Tianqi capsule: a systematic review and meta-analysis

“…The prevalence of prediabetes is 50.1%, accounting for a total of 493.4 million people in China [2], and 70.7% of those with prediabetes had IGT [3] and form an important high-risk target group for intervention aimed at preventing T2DM [4,5]. Current guidelines recommend that IGT patients undergo lifestyle modifications, which have been shown to be effective for reducing the incidence of T2DM [6][7][8].…”