The Prevention or Delay of Type 2 Diabetes

Reprinted with permission from Diabetes Care 25:742–749, 2002

Editor’s note: We are reprinting this position statement in Diabetes Spectrum because of its critical message. We, as educators and clinicians, are being asked for direction about how to influence the epidemic of diabetes in our communiities. I believe that helping to prevent or delay diabetes is as much a part of our role as helping to reduce our patients’ risk of developing the complications of diabetes.—BPC

Diabetes is one of the most costly and burdensome chronic diseases of our time and is a condition that is increasing in epidemic proportions in the U.S. and throughout the world.1 The complications resulting from the disease are a significant cause of morbidity and mortality and are associated with the damage or failure of various organs such as the eyes, kidneys, and nerves. Individuals with type 2 diabetes are also at a significantly higher risk for coronary heart disease, peripheral vascular disease, and stroke, and they have a greater likelihood of having hypertension, dyslipidemia, and obesity.2–6

There is also growing evidence that at glucose levels above normal but below the threshold diagnostic for diabetes, there is a substantially increased risk of cardiovascular disease (CVD) and death.5,7–10 In these individuals, CVD risk factors are also more prevalent,5–7,9,11–14 which further increases the risk but is not sufficient to totally explain it.

In contrast to the clear benefit of glucose lowering to prevent or retard the progression of microvascular complications associated with diabetes,15–18,21 it is less clear whether the high rate of CVD in people with impaired glucose homeostasis, i.e., those with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or diabetes, is caused by …