Ms. Plaut is now a student at the University of Illinois at Chicago School of Medicine, Chicago, IL, USA.
Preventing Diabetes in the Clinical Setting
Article first published online: 9 NOV 2005
Journal of General Internal Medicine
Volume 21, Issue 1, pages 84–93, January 2006
How to Cite
Burnet, D. L., Elliott, L. D., Quinn, M. T., Plaut, A. J., Schwartz, M. A. and Chin, M. H. (2006), Preventing Diabetes in the Clinical Setting. Journal of General Internal Medicine, 21: 84–93. doi: 10.1111/j.1525-1497.2005.0277.x
Dr. Elliott is now on faculty at Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Issue published online: 5 JAN 2006
- Article first published online: 9 NOV 2005
- Manuscript received April 6, 2005 Initial editorial decision June 22, 2005 Final acceptance August 30, 2005
- type 2 diabetes;
- physical activity
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.