The prevention of type 2 diabetes mellitus.

With a worldwide pandemic of type 2 diabetes upon us, it is imperative that effective and practical preventive strategies be developed for this disease which, once established, carries with it excess morbidity and mortality. This article reviews recently published data on the prevention of type 2 diabetes and compares the demonstrated effectiveness of each strategy, including lifestyle modification and several pharmacologic agents. Although much new information is available, many translational questions remain that chiefly concern the generalizability and applicability of these programs to clinical practice. Recent diabetes prevention guidelines are discussed, and a practical framework for their implementation is presented.     

Primary prevention of type 2 diabetes mellitus by lifestyle intervention: implications for health policy

More than 18 million Americans currently have diabetes mellitus. The economic and human cost of the disease is devastating. In the United States, diabetes is the most common cause of blindness among working-age adults, the most common cause of nontraumatic amputations and end-stage renal disease, and the sixth most common cause of death. For the cohort of Americans born in 2000, the estimated lifetime risk for diabetes is more than 1 in 3. In the next 50 years, the number of diagnosed cases of diabetes is predicted to increase by 165% in the United States, with the largest relative increases seen among African Americans, American Indians, Alaska Natives, Asian and Pacific Islanders, and Hispanic/Latino persons. Compelling scientific evidence indicates that lifestyle change prevents or delays the occurrence of type 2 diabetes in high-risk groups. This body of evidence from randomized, controlled trials conducted in 3 countries has definitively established that maintenance of modest weight loss through diet and physical activity reduces the incidence of type 2 diabetes in high-risk persons by about 40% to 60% over 3 to 4 years. The number of persons at high risk for type 2 diabetes is similar to the number of persons who have diabetes. This paper summarizes scientific evidence supporting lifestyle intervention to prevent type 2 diabetes and discusses major policy challenges to broad implementation of lifestyle intervention in the health system.     

Primary prevention of Type 2 (non-insulin-dependent) diabetes mellitus

Summary Type 2 (non-insulin-dependent) diabetes mellitus is the major form of the disease in all societies. Its public health impact appears to be increasing and the greatest genetic predisposition to the disease is encountered in developing communities. The reduction or elimination of disease in whole populations is a fundamental goal in public health. Whilst several factors are associated with the development of Type 2 diabetes, it is not clear how they cause the disease, if indeed they do, nor whether they act in the same way in all populations. Risk factors may be true determinants of a disease but alternatively they may be associated with its occurrence only by virtue of an innocent relationship with the true causes. Furthermore, known risk factors usually explain only a small proportion of any chronic disease. The role of risk factors in disease causation is therefore of fundamental importance in considering disease prevention. Two alternative strategies for prevention of disease in populations have been proposed. The population strategy seeks to remove the causes of disease in communities as a whole, whilst the high-risk strategy aims to identify subjects at increased risk, and to intervene selectively. The population approach should be tried and carefully evaluated in selected communities at above-average risk of several noncommunicable diseases. However, certain epidemiological features of Type 2 diabetes, including the distributional characteristics of glycaemia and the complications of hyperglycaemia, the clustering of cardiovascular risk factors in the diabetic subpopulation, as well as uncertainties over the causal nature of known risk factors, suggest that a high-risk approach to prevention is also appropriate. Optimal allocation of resources to the two approaches requires a detailed knowledge of the disease process in individual communities.     

Nonpharmacological interventions for the prevention of type 2 diabetes mellitus

During the past decade, improved understanding of the pathophysiological mechanisms of diabetes development has resulted in advances in therapeutic concepts, but has also supported the potential for diabetes prevention through nonpharmacological means. At the beginning of the century, we experienced a shift in paradigm, as landmark studies have shown that diabetes mellitus is preventable with lifestyle intervention; moderate changes in diet and physical activity produce a substantial and sustained reduction in the incidence of type 2 diabetes mellitus (T2DM) for individuals with impaired glucose tolerance. This evidence must now be translated into clinical and public-health practice, but translational studies have varied in their ability to replicate the results of clinical trials. This variation reflects a number of challenging barriers for diabetes prevention in real-world clinical practice, which makes it necessary to focus on identifying efficient intervention methods and delivery mechanisms. Research is now focusing on these mechanisms, as well as on developing efficient screening and risk-identification strategies and realistic scenarios for public-health policy to implement diabetes prevention programs. In this Review, we will discuss these mechanisms and will consider the implications of diabetes prevention for public-health strategy and policy.     

Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus

Gestational diabetes mellitus (GDM) affects approximately 4% of all pregnant women in the US and represents 90% of all cases of diabetes mellitus diagnosed during pregnancy. In addition to the adverse pregnancy outcomes associated with this complication, a history of GDM predisposes women to the future development of type 2 diabetes mellitus (T2DM). Incidence rates of GDM are increasing in the US. As a consequence, a growing number of women are now at increased risk for T2DM. Opportunities to diagnose and prevent T2DM in women with a history of GDM include early diagnosis by postpartum screening and implementation of diabetes prevention measures. In this Review, we discuss current guidelines for postpartum screening, how they might be implemented, and who should take responsibility for screening individuals at risk of T2DM. In addition, we describe measures to prevent the onset of T2DM in women with a history of GDM, focusing on lifestyle modifications, such as diet and breast-feeding.     

Primary prevention of diabetes mellitus by nutritional correction

Nutrition and the status of carbohydrate and lipid metabolism were investigated in an organized population of men aged 20 to 59. Nutritional correction was based on the results obtained. Repeated investigation of the same population in 3 years has shown that a decrease in the caloric content of the daily ration at the expense of fats and carbohydrates, especially starch and refined sugars, causes a decrease in the level of basal insulin, mean values of glycemia during a GTT, and atherogenic fractions of the lipid spectrum. Correlation between the level of glycemia and the ratio of polyunsaturated and saturated fatty acids was established. Nutritional correction as a prophylactic method was shown to be more effective in persons of younger age.     

Gene-environment interactions in the pathogenesis and prevention of type 2 diabetes mellitus

Type 2 diabetes mellitus is a chronic progressive disease characterized by impaired insulin secretion of the beta cell and impaired insulin sensitivity of different tissues. The incidence of type 2 diabetes mellitus is increasing worldwide, and the disease has reached epidemic proportions. Lifestyle intervention programs are able to delay or possibly prevent the manifestation of type 2 diabetes mellitus. This review summarizes the genetic and environmental factors which influence the risk for type 2 diabetes and their interactions, and determine the success of prevention programs.     

1型糖尿病的二级预防临床研究进展

1型糖尿病是一种器官特异性自身免疫性疾病,目前尚无根治方法,患者需要终身胰岛素替代治疗。将1型糖尿病防患于未然,是患者和医师的梦想。近年来,易感基因和胰岛自身抗体检测方面的进展为1型糖尿病前期的预测和预防提供了理论依据和技术可能。此外,1型糖尿病二级预防的免疫干预治疗也取得了一定的成效。现对1型糖尿病二级预防的最新研究...     

Cdk5与替米沙坦2型糖尿病预防作用的关系

细胞周期素依赖性蛋白激酶(Cdk)5介导的过氧化物酶体增殖物活化受体(PPAR)γ磷酸化通过干扰脂联素等胰岛素敏感性相关细胞因子的基因表达,引起胰岛素抵抗并最终引发2型糖尿病.替米沙坦一方面通过改变PPARγ的蛋白构象使其273位丝氨酸不能与Cdk5结合来调控PPARγ功能;另一方面,作为抑制血管紧张素Ⅱ1型受体阻断剂...     

2型糖尿病流行病学

一、概述2型糖尿病占糖尿病总体人群95%以上,患病率高,起病隐匿,早期症状不明显,流行病学主要调查其患病率。1型糖尿病比较罕见,典型者多见于儿童,流行病学常常调查其儿童人群的年发病率。1型糖尿病流行病学调查往往有专门说明。其实胰岛β细胞自身免疫损伤所致的1型糖尿病可以     

Pathogenesis of type 2 diabetes mellitus

"Common" type 2 diabetes mellitus is a multifactorial disease. Hyperglycemia is related to a decrease in glucose peripheral uptake, and to an increase in hepatic glucose production, due to reduced insulin secretion and insulin sensitivity. Multiple insulin secretory defects are present, including loss of basal pulsatility, lack of early phase of insulin secretion after intravenous glucose administration, decreased basal and stimulated plasma insulin concentrations, excess in prohormone secretion, and progressive decrease in insulin secretory capacity with time. These genetically determined abnormalities appear early in the course of the disease. Insulin resistance affects muscle, liver, and adipose tissue. For the same plasma insulin levels, peripheral glucose uptake and hepatic glucose production suppressibility are lower in diabetic patients than in controls. It results from aging of the population and from "western" lifestyle, with progressive increase in mean body weight, due to excess in energy intake, decreased energy expenses and low physical activity level. NEW ASPECTS: The role of beta-cell dysfunction, as well as the interplay between insulin secretory defect and insulin resistance are now better understood. In subjects with normal beta-cell function, increase in insulin needs secondary to insulin resistance is compensated by an increase in insulin secretion adjusted to maintain plasma glucose levels to normal. In subjects genetically predisposed to type 2 diabetes, failure of beta-cell to compensate for increased needs is responsible for a progressive elevation in plasma glucose levels, then for overt type 2 diabetes. This adaptative phenomenon is called beta-cell compensation of insulin resistance. The lack of compensation is responsible for type 2 diabetes. When permanent hyperglycemia is present, progressive insulin secretory failure with time ensues, due to glucotoxicity and to lipotoxicity. PERSPECTIVES: Simple changes in lifestyle, such regular moderate physical activity, and control of body weight, should permit to avoid the explosion in prevalence of type 2 diabetes. This has been evidenced by the results of prospective studies aiming at preventing conversion from impaired glucose tolerance to diabetes. In patients with permanent hyperglycemia not controlled by lifestyle changes, metabolic defects are the targets of specific therapy intervention with antidiabetic oral agents, such as insulin secretagogues, insulin sensitizers, and inhibitors of hepatic glucose production.     

Etiopathogenesis of type 2 diabetes mellitus

In the genesis and development of type 2 diabetes in the great majority of subjects the contemporary lifestyle characterized by inadequate physical activity and an excessive energy intake is of basic importance. The majority of abnormalities and defects revealed by laboratory tests is probably secondary and caused by the above mentioned factors. Contemporary views of the etiopathogenesis of the disease are demotivating for patients: if the cause of their disease were an inborn disorder at the level of transmission of a signal on membranes then probably nothing else can be done than to take prescribed drugs. If the mistake involves the lifestyle, the latter can be changed and the disease avoided. Any medicamentous treatment is associated with the risk of undesirable effects--the complication of hyperinsulinism in treatment with sulphonyl urea derivatives and insulin or lactate acidosis after treatment with biguanides. This risk is not influenced by early prevention: dietary restraint and adequate physical exercise. Diabetes type 2 and 1--despite the common sign of hyperglycaemia--are characterized by a fundamental difference: (not influenced by treatment) DM type 1 is characterized by enhanced catabolic processes, starvation at the cellular level. Type 2 is characterized by enhanced anabolic processes, excessive amounts of nutrients in cells. The authors submit recommendations which respect the secondary character of deviations for the development of DM 2 which can be detected by laboratory methods: The following are the basic etiopathogenetic mechanism for the development of DM 2: 1. Chronic excessive intake and inadequate output of energy a) increased nutrient supply to the liver with secondary increase of gluconeogenesis in the liver, b) chronic increased supply of glucose to peripheral tissues, in particular muscles and adipose tissue, inadequate physical exercise, with secondary restriction of nutrient supplies to these tissues. 2. Secondary affection of insulin secretion in the islets of Langerhans in the pancreas.     

Prevention of type 2 diabetes mellitus

Type 2 Diabetes mellitus (DM2) is a complex, multifactorial and worldwide metabolic disease that affects quality and lifestyle of patients. Patients with diabetes can have a 15-year or more reduction of lifetime and the high mortality is due to cardiovascular (CV) complications. Effective strategies for the reduction of the impact of DM2 on CV disorders for the next years and attention concerning to strategies of prevention, mainly for the populations with larger risk of developing the disease, are essential. In that context, impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG) must suffer intervention strategies in order to minimize the risk for diabetes. Behavior modification (diet therapy and physical activity) must be stimulated, and pharmacological agents have to be used when indicated. Studies worldwide have been confirming the effectiveness of lifestyle strategies and even the use of pharmacological agents for the prevention of DM2.