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The major diabetes prevention trials

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Abstract

Type 2 diabetes (T2D) is a devastating disease with multiple complications affecting many tissues, most notably the cardiovascular system. To be able to prevent a chronic disease such as T2D, certain requirements have to be met. Knowledge about its natural history with a preclinical phase, modifiable risk factors, effective and simple screening tools to identify high-risk subjects, and effective intervention that is affordable and acceptable are necessary. In addition, the efficacy of the intervention has to be proven under a clinical trial setting. Several major lifestyle intervention trials have been successfully carried out, with consistent results: the risk of T2D in high-risk subjects can be halved, the effect of lifestyle changes is rapid, and benefits are similar in different ethnic groups. Thus, the prevention of T2D is possible in most high-risk subjects, but how to achieve this at the population level remains a major challenge.

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References and Recommended Reading

  1. Joslin E: The prevention of diabetes mellitus. JAMA 1921, 76:79–84.

    Google Scholar 

  2. WHO Study Group: Primary Prevention of Diabetes Mellitus— Technical Report Series No 844. Geneva; 1994. Report No. 844.

  3. Kosaka K, Hagura R, Kuzuya T: Insulin responses in equivocal and definite diabetes, with special reference to subjects who had mild glucose intolerance but later developed definite diabetes. Diabetes 1977, 26:944–952.

    PubMed  CAS  Google Scholar 

  4. Ward WK, Beard JC, Halter JB, et al.: Pathophysiology of insulin secretion in non-insulin-dependent diabetes mellitus. Diabetes Care 1984, 7:491–502.

    Article  PubMed  CAS  Google Scholar 

  5. Bruce DG, Chisholm DJ, Storlien LH, et al.: Physiological importance of deficiency in early prandial insulin secretion in noninsulin-dependent diabetes. Diabetes 1988, 37:736–744.

    Article  PubMed  CAS  Google Scholar 

  6. Manson JE, Rimm EB, Stampfer MJ, et al.: Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet 1991, 338:774–778.

    Article  PubMed  CAS  Google Scholar 

  7. Tuomilehto J, Tuomilehto-Wolf E, Zimmet P, et al.: Primary prevention of diabetes mellitus. In International Textbook of Diabetes Mellitus, edn 2. Edited by Alberti K, et al. Chichester, NY: John Wiley & Sons; 1997:1799–1827.

    Google Scholar 

  8. Neel JV: Diabetes mellitus: a “thrifty” genotype rendered detrimental by progress? Am J Hum Genet 1962, 14:353–362.

    PubMed  CAS  Google Scholar 

  9. Kahn CR, Vicent D, Doria A: Genetics of non-insulin-dependent (type-II) diabetes mellitus. Annu Rev Med 1996, 47:509–531.

    Article  PubMed  CAS  Google Scholar 

  10. King H, Aubert RE, Herman WH: Global burden of diabetes, 1995-2025. Diabetes Care 1998, 21:1414–1431.

    Article  PubMed  CAS  Google Scholar 

  11. Hamman R: Prevention of Type 2 diabetes. In The Evidence for Diabetes Care. Edited by Williams R, et al. Chichester, NY: John Wiley & Sons; 2002:75–176. Extensive review of intervention studies aimed at reversing the deterioration of glucose tolerance.

    Chapter  Google Scholar 

  12. Sartor G, Schersten B, Carlstrom S, et al.: Ten-year follow-up of subjects with impaired glucose tolerance. Prevention of diabetes by tolbutamide and diet regulation. Diabetes 1980, 29:41–49.

    Article  PubMed  CAS  Google Scholar 

  13. Eriksson KF, Lindgarde F: Prevention of type 2 (non-insulin- dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmo feasibility study. Diabetologia 1991, 34:891–898.

    Article  PubMed  CAS  Google Scholar 

  14. Knowler W, Narayan K, Hanson R, et al.: Perspectives in Diabetes. Preventing non-insulin-dependent diabetes. Diabetes 1995, 44:483–488.

    Article  PubMed  CAS  Google Scholar 

  15. Pan XR, Li GW, Hu YH, et al.: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997, 20:537–544.

    Article  PubMed  CAS  Google Scholar 

  16. Eriksson J, Lindström J, Valle T, et al.: Prevention of type II diabetes in subjects with impaired glucose tolerance: the Diabetes Prevention Study (DPS) in Finland. Study design and 1- year interim report on the feasibility of the lifestyle intervention programme. Diabetologia 1999, 42:793–801.

    Article  PubMed  CAS  Google Scholar 

  17. Uusitupa M, Louheranta A, Lindström J, et al.: The Finnish Diabetes Prevention Study. Brit J Nutr 2000, 83:S137-S142.

    PubMed  CAS  Google Scholar 

  18. Tuomilehto J, Lindström J, Eriksson J, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343–1350. The first controlled, individually randomized study to prove thatT2D is preventable by lifestyle intervention.

    Article  PubMed  CAS  Google Scholar 

  19. The Diabetes Prevention Program. Design and methods for a clinical trial in the prevention of type 2 diabetes [no authors listed]. Diabetes Care 1999, 22:623–634.

  20. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin [no authors listed]. N Engl J Med 2002, 346:393–403. A large intervention study that confirmed the findings from the DPS and demonstrated the effectiveness of a lifestyle intervention also in different ethnic and age groups.

  21. The Diabetes Prevention Program (DPP). Description of lifestyle intervention [no authors listed]. Diabetes Care 2002, 25:2165–2171.

  22. Chiasson J-L, Josse RG, Gomis R, et al.: Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 2002, 359:2072–2077.

    Article  PubMed  CAS  Google Scholar 

  23. Chiasson JL, Gomis R, Hanefeld M, et al.: The STOP-NIDDM Trial: an international study on the efficacy of an alpha-glucosi- dase inhibitor to prevent type 2 diabetes in a population with impaired glucose tolerance: rationale, design, and preliminary screening data. Study to Prevent Non-Insulin-Dependent Diabetes Mellitus. Diabetes Care 1998, 21:1720–1725.

    Article  PubMed  CAS  Google Scholar 

  24. Azen SP, Peters RK, Berkowitz K, et al.: TRIPOD (TRoglitazone In the Prevention Of Diabetes): a randomized, placebo-controlled trial of troglitazone in women with prior gestational diabetes mellitus. Control Clin Trials 1998, 19:217–231.

    Article  PubMed  CAS  Google Scholar 

  25. Buchanan TA, Xiang AH, Peters RK, et al.: Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high- risk Hispanic women. Diabetes 2002, 51:2796–2803.

    Article  PubMed  CAS  Google Scholar 

  26. Kjos SL, Peters RK, Xiang A, et al.: Predicting future diabetes in Latino women with gestational diabetes. Utility of early post- partum glucose tolerance testing. Diabetes 1995, 44:586–591.

    Article  PubMed  CAS  Google Scholar 

  27. Dyson PA, Hammersley MS, Morris RJ, et al.: The Fasting Hyperglycaemia Study: II. Randomized controlled trial of reinforced healthy-living advice in subjects with increased but not diabetic fasting plasma glucose. Metabolism 1997, 46:50–55.

    Article  PubMed  CAS  Google Scholar 

  28. Shaw JE, Zimmet PZ, de Courten M, et al.: Impaired fasting glucose or impaired glucose tolerance. What best predicts future diabetes in Mauritius? Diabetes Care 1999, 22:399–402.

    Article  PubMed  CAS  Google Scholar 

  29. Yang W, Lin L, Yu Z, et al.: The preventive affect of acarbose and metformin on the progression to diabetes mellitus in the IGT population: a 3-year multicenter prospective study. Chin J Endocrinol Metab 2001, 17:131–136.

    CAS  Google Scholar 

  30. Tataranni PA, Bogardus C: Changing habits to delay diabetes. N Engl J Med 2001, 344:1390–1392.

    Article  PubMed  CAS  Google Scholar 

  31. Sjöström CD, Lissner L, Wedel H, et al.: Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res 1999, 7:477–484.

    PubMed  Google Scholar 

  32. Sjöström L, Torgerson JS, Hauptman J, et al.: XENDOS (XENical in the prevention of Diabetes in the Obese Subjects): a landmark study. Paper presented at the 9th International Congress on Obesity. Sao Paulo, Brazil, 2002.

  33. Dabelea D, Hanson RL, Bennett PH, et al.: Increasing prevalence of type II diabetes in American Indian children. Diabetologia 1998, 41:904–910.

    Article  PubMed  CAS  Google Scholar 

  34. Ehtisham S, Barrett TG, Shaw NJ: Type 2 diabetes mellitus in UK children—an emerging problem. Diabet Med 2000, 17:867–871.

    Article  PubMed  CAS  Google Scholar 

  35. Sinha R, Fisch G, Teague B, et al.: Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002, 346:802–810.

    Article  PubMed  CAS  Google Scholar 

  36. Invitti C, Guzzaloni G, Gilardini L, et al.: Prevalence and concomitants of glucose intolerance in european obese children and adolescents. Diabetes Care 2003, 26:118–124.

    Article  PubMed  Google Scholar 

  37. Dabelea D, Pettitt DJ, Hanson RL, et al.: Birth weight, type 2 diabetes, and insulin resistance in Pima Indian children and young adults. Diabetes Care 1999, 22:944–950.

    Article  PubMed  CAS  Google Scholar 

  38. Forsén T, Eriksson J, Tuomilehto J, et al.: The fetal and childhood growth of persons who develop type 2 diabetes. Ann Intern Med 2000, 133:176–182.

    PubMed  Google Scholar 

  39. Lindstrom J, Tuomilehto J: The Diabetes Risk Score. A practical tool to predict type 2 diabetes risk. Diabetes Care 2003, in press.

  40. Finnish Diabetes Association: Development programme for the prevention and care of diabetes in Finland 2000-2010. http://www.diabetes.fi/english/programme/. Accessed on October 30, 2002.

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Authors and Affiliations

  1. Department of Epidemiology and Health Promotion, National Public Health Institute, Diabetes and Genetic Epidemiology Unit, Mannerheimintie 166, 00300, Helsinki, Finland

    Jaakko Tuomilehto MD, MPolSc, PhD

Authors
  1. Jaakko Tuomilehto MD, MPolSc, PhD
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  2. Jaana Lindström MSc
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Tuomilehto, J., Lindström, J. The major diabetes prevention trials. Curr Diab Rep 3, 115–122 (2003). https://doi.org/10.1007/s11892-003-0034-9

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  • DOI: https://doi.org/10.1007/s11892-003-0034-9

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