Recommendations: Prevention/Delay of Type 2 Diabetes

Recommendations for the prevention/delay of type 2 diabetes1 are summarized on two slides Slide 2 of 2 Metformin has a strong evidence base and demonstrated long-term safety2 Metformin may be recommended for very high-risk individuals (those with a history of GDM, the very obese, and/or those with more severe or progressive hyperglycemia) Of note, in the Diabetes Prevention Program (DPP), metformin was not significantly better than placebo in those over age 60 years3 For other drugs, issues of cost, side effects, and lack of persistence of effect in some studies4 require consideration People with prediabetes often have other CVD risk factors, such as obesity, hypertension, and dyslipidemia; in the DPP and DPPOS, cardiovascular event rates have been very low, perhaps due to appropriate management of cardiovascular risk factors in all study arms522References American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013;36(suppl 1):S16. Diabetes Prevention Program Research Group. Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Study. Diabetes Care 2012;35:731-737. Knowler WC, Barrett-Connor E, Fowler SE, et al for the Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403. DREAM Trial Investigators. Incidence of diabetes following ramipril or rosiglitazone withdrawal. Diabetes Care 2011;34:1265-1269. Orchard TJ, Temprosa M, Barrett-Connor E, et al.; The Diabetes Prevention Program Outcomes Study Research Group; prepared on behalf of the DPPOS Research Group. Long-term effects of the Diabetes Prevention Program interventions on cardiovascular risk factors: a report from the DPP Outcomes Study. Diabet Med 19 July 2012 [Epub ahead of print]