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We can change the natural history of type 2 diabetes

Lawrence S Phillips1, Robert E Ratner2, John B Buse3

  • 1Atlanta VA Medical Center, Decatur, GA Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA lawrence.phillips@emory.edu.

Diabetes Care
|September 25, 2014
PubMed

Insights

Early detection and effective treatment of prediabetes and early diabetes can prevent or delay hyperglycemia and complications. Interventions show lasting benefits, suggesting proactive management can alter the disease

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Preventive Medicine

Background:

  • Diabetes mellitus natural history involves a significant preclinical phase.
  • Current diagnostic approaches often identify diabetes after substantial hyperglycemia and potential complications have developed.
  • Early intervention in prediabetes and early diabetes is crucial for altering disease trajectory.

Purpose of the Study:

  • To evaluate the impact of early detection and effective management of prediabetes and early diabetes.
  • To determine if interventions can prevent or delay the progression of hyperglycemia and associated complications.
  • To assess the long-term effects of interventions after their withdrawal.

Main Methods:

  • Review of evidence from clinical trials involving lifestyle changes and/or glucose-lowering medications.
  • Analysis of cumulative diabetes development in treated versus control groups.
  • Examination of the association between transient normal glucose levels and subsequent diabetes incidence.

Main Results:

  • Interventions like lifestyle changes and medications reduced progression from prediabetes to diabetes.
  • Previously treated groups showed less cumulative diabetes development even after intervention withdrawal.
  • Transient achievement of normal glucose levels significantly reduced subsequent diabetes development.

Conclusions:

  • Routine screening for prediabetes and early diabetes is recommended.
  • Management strategies should aim for glucose levels as close to normal as possible without causing hypoglycemia.
  • A randomized controlled trial is proposed to further test these findings.

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