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Preventing diabetes in the clinical setting

  • Clinical Review
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Abstract

OBJECTIVE: Translating lessons from clinical trials on the prevention or delay of type 2 diabetes to populations in nonstudy settings remains a challenge. The purpose of this paper is to review, from the perspective of practicing clinicians, available evidence on lifestyle interventions or medication to prevent or delay the onset of type 2 diabetes.

DESIGN: A MEDLINE search identified 4 major diabetes prevention trials using lifestyle changes and 3 using prophylactic medications. We reviewed the study design, key components, and outcomes for each study, focusing on aspects of the interventions potentially adaptable to clinical settings.

RESULTS: The lifestyle intervention studies set modest goals for weight loss and physical activity. Individualized counseling helped participants work toward their own goals; behavioral contracting and self-monitoring were key features, and family and social context were emphasized. Study staff made vigorous follow-up efforts for subjects having less success. Actual weight loss by participants was modest; yet, the reduction in diabetes incidence was quite significant. Prophylactic medication also reduced diabetes risk; however, lifestyle changes were more effective and are recommended as first-line strategy. Cost-effectiveness analyses have shown both lifestyle and medication interventions to be beneficial, especially as they might be implemented in practice.

CONCLUSION: Strong evidence exists for the prevention or delay of type 2 diabetes through lifestyle changes. Components of these programs may be adaptable for use in clinical settings. This evidence supports broader implementation and increased reimbursement for provider services related to nutrition and physical activity to forestall morbidity from type 2 diabetes.

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Author information

Author notes

  1. Lorrie D. Elliott MD

    Present address: Section of Endocrinology, Department of Medicine, Diabetes Research and Training Center, The University of Chicago, Chicago, IL, USA

  2. Andrea J. Plaut MPH

    Present address: Northwestern University Feinberg School of Medicine, Chicago, IL, USA

Authors and Affiliations

  1. Section of General Internal Medicine, Department of Medicine, Diabetes Research and Training Center, The University of Chicago, Chicago, IL, USA

    Deborah L. Burnet MD, MA, Lorrie D. Elliott MD, Andrea J. Plaut MPH, Mindy A. Schwartz MD & Marshall H. Chin MD, MPH

  2. Section of Endocrinology, Department of Medicine, Diabetes Research and Training Center, The University of Chicago, Chicago, IL, USA

    Michael T. Quinn PhD

Authors
  1. Deborah L. Burnet MD, MA
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  2. Lorrie D. Elliott MD
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  3. Michael T. Quinn PhD
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  5. Mindy A. Schwartz MD
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Corresponding author

Correspondence to Deborah L. Burnet MD, MA.

Additional information

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Research and Training Center (P60 DK20595). Dr. Burnet is supported by a Mentored, Patient Oriented, Career Development Award (K23 DK064073-01), and Dr. Chin was a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar.

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Burnet, D.L., Elliott, L.D., Quinn, M.T. et al. Preventing diabetes in the clinical setting. J GEN INTERN MED 21, 84–93 (2006). https://doi.org/10.1111/j.1525-1497.2005.0277.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.0277.x

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