Prediabetes: lifestyle, pharmacotherapy or regulation?

The rapidly rising number of people with diabetes worldwide has led to multiple attempts to identify effective means of preventing type 2 diabetes. Lifestyle interventions have shown impressive efficacy in multiple clinical trials of people with impaired glucose tolerance, but, as currently formulated, appear to have very little impact on impaired fasting glucose. Attempts to roll out lifestyle interventions beyond clinical trials have generally recruited too few people to have a chance of influencing the population prevalence of diabetes. Several drugs have also been shown to reduce the incidence of diabetes, but until such drugs can be shown to prevent the clinical consequences of diabetes, it is unlikely that guidelines will recommend their widespread use for diabetes prevention. Population-level interventions, including education and regulation, are attractive, as they have the potential to influence a high proportion of the population. Favourable effects of a sugar sweetened beverage tax on consumption are encouraging, but data on its influence on diabetes are not yet available.