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lected to approximate at least 700 kcal/week expenditure from physical activity.For ease of translation, this goal was de-scribed as at least 150 min of moderate-intensity physical activity per week, similarin intensity to brisk walking. Participantswere encouraged to distribute their activ-ity throughout the week with... | [
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their activ-ity throughout the week with a minimumfrequency of three times per week and atleast 10 min per session. A maximum of75 min of strength training could be ap-plied toward the total 150 min/weekphysical activity goal (11). | [
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To implement the weight loss and physi-\ncal activity goals, the DPP used an individ-ual model of treatment rather than agroup-based approach. This choice wasbased on a desire to intervene before par-\nticipants had the possibility of developing | [
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ticipants had the possibility of developing\ndiabetes or losing interest in the program.The individual approach also allowed forthe tailoring of interventions to refl ect the\ndiversity of the population (11).\nThe DPP intervention was adminis-\ntered as a structured core curriculum fol-lowed by a flexible maintenance pr... | [
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of individual counseling, group sessions,motivational campaigns, and restart op-portunities. The 16-session core curricu-lum was completed within the first | [
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24 weeks of the program. It includedsessions on lowering calories, increasingphysical activity, self-monitoring, main-taining healthy lifestyle behaviors (suchas how to choose healthy food optionswhen eating out), and guidance on man-aging psychological, social, and motiva-tional challenges. Further details area v a i ... | [
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challenges. Further details area v a i l a b l er e g a r d i n gt h ec o r ec u r r i c u l u msessions (11). | [
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Nutrition\nNutrition counseling for weight loss in theDPP lifestyle intervention arm included aS44 Prevention or Delay of Diabetes Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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reduction of total dietary fat and calories\n(4,11,12). However, evidence suggests that\nthere is not an ideal percentage of caloriesfrom carbohydrate, protein, and fat forall people to prevent diabetes; therefore,\nmacronutrient distribution should be based | [
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macronutrient distribution should be based\non an individualized assessment of currenteating patterns, preferences, and meta-bolic goals (13). Based on other trials, a va-\nriety of eating patterns (13,14) may also be\nappropriate for individuals with prediabe-tes (13), including Mediterranean-style andlow-carbohydrate... | [
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servational studies have also shown thatvegetarian, plant-based (may include someanimal products), and Dietary Approachesto Stop Hypertension (DASH) eating pat-\nterns are associated with a lower risk of\ndeveloping type 2 diabetes (19 –22). Evi-\ndence suggests that the overall quality offood consumed (as measured by ... | [
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Healthy Eating Index, Alternative Healthy\nEating Index, and DASH score), with anemphasis on whole grains, legumes, nuts,fruits, and vegetables and minimal re-\nfined and processed foods, is also associ-\nated with a lower risk of type 2 diabetes\n(21,23– 2 5 ) .A si st h ec a s ef o rt h o s ew i t h\ndiabetes, individ... | [
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diabetes, individualized medical nutrition\ntherapy (see Section 5, “Facilitating\nPositive Health Behaviors and Well-being\nto Improve Health Outcomes, ”for more\ndetailed information) is effective in lower-\ning A1C in individuals diagnosed with pre-\ndiabetes (26).\nPhysical Activity | [
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diabetes (26).\nPhysical Activity\nModerate-intensity physical activity, suchas brisk walking for 150 min/week, hasshown bene ficial effects in those with\nprediabetes (4). Similarly, moderate-intensity physical activity has been shownto improve insulin sensitivity and reduceabdominal fat in children and young\nadults (... | [
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adults (27,28). Health care professionals\nare encouraged to promote a DPP-styleprogram to all individuals who have beenidenti fied to be at an increased risk of\ntype 2 diabetes. In addition to aerobicactivity, a physical activity plan designedto prevent diabetes may include resis-tance training (11,29,30). Breaking up | [
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prolonged sedentary time may also be\nencouraged, as it is associated withmoderately lower postprandial glucoselevels (31,32). The effects of physical ac-\ntivity appear to extend to the prevention\nof gestational diabetes mellitus (GDM)(33).Delivery and Dissemination of\nLifestyle Behavior Change for\nDiabetes Prevent... | [
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Lifestyle Behavior Change for\nDiabetes Prevention\nBecause the intensive lifestyle interven-\ntion in the DPP was effective in prevent-\ning type 2 diabetes among those at high\nrisk for the disease and lifestyle behaviorchange programs for diabetes prevention\nwere shown to be cost-effective, broader | [
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were shown to be cost-effective, broader\nefforts to disseminate scalable lifestylebehavior change programs for diabetesprevention with coverage by third-party\npayers ensued (34 –38). Group delivery of\nDPP content in community or primary\ncare settings has demonstrated the po-\ntential to reduce overall program costs | [
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tential to reduce overall program costs\nwhile still producing weight loss and dia-betes risk reduction (39 –43).\nThe Centers for Disease Control and\nPrevention (CDC) developed the NationalDiabetes Prevention Program (NationalDPP), a resource designed to bring suchevidence-based lifestyle change programs\nfor prevent... | [
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for preventing type 2 diabetes to commu-\nnities (cdc.gov/diabetes/prevention/index.htm). This online resource includes loca-\ntions of CDC-recognized diabetes preven-\ntion lifestyle change programs (cdc.gov/diabetes/prevention/ find-a-program.html).\nTo be eligible for this program, individuals\nm u s th a v eaB M Ii ... | [
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m u s th a v eaB M Ii nt h eo v e r w e i g h tr a n g e\nand be at risk for diabetes based on labo-ratory testing, a previous diagnosis of\nGDM, or a positive risk test (cdc.gov/\nprediabetes/takethetest/). During the first\n4 years of implementation of the CDC’ s\nNational DPP, 36% achieved the 5% weight\nloss goal (4... | [
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loss goal (44). The CDC has also developed\nthe Diabetes Prevention Impact Tool Kit(nccd.cdc.gov/toolkit/diabetesimpact) to\nhelp organizations assess the economics\nof providing or covering the National DPP(45). To expand preventive services usinga cost-effective model, the Centers for\nMedicare & Medicaid Services ex... | [
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Medicare & Medicaid Services expanded\nMedicare reimbursement coverage forthe National DPP to organizations recog-\nnized by the CDC that become Medicare\nsuppliers for this service (innovation.cms.gov/innovation-models/medicare-diabetes-prevention-program). The loca-\ntions of Medicare DPPs are available on- | [
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tions of Medicare DPPs are available on-\nline at innovation.cms.gov/innovation-models/medicare-diabetes-prevention\n-program/mdpp-map. To qualify for Medi-\ncare coverage, individuals must have BMI>25 kg/m\n2(or BMI >23 kg/m2if self-\nidentifi ed as Asian) and glycemic testing | [
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2(or BMI >23 kg/m2if self-\nidentifi ed as Asian) and glycemic testing\nconsistent with prediabetes in the lastyear. Medicaid coverage of the NationalD P Pi sa l s oe x p a n d i n go nas t a t e - b y - s t a t e\nbasis.\nWhile CDC-recognized behavioral counsel-\ning programs, including Medicare DPPservices, have met m... | [
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standards and are reimbursed by many\npayers, lower retention rates have beenreported for younger adults and racialand ethnic minority populations (46).Therefore, other programs and modalities\nof behavioral counseling for diabetes pre-\nvention may also be appropriate and ef fi- | [
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vention may also be appropriate and ef fi-\ncacious based on individual preferencesand availability. The use of community\nhealth workers to support DPP-like inter-\nventions has been shown to be effectiveand cost-effective (47,48) (see Section 1,“Improving Care and Promoting Health in\nPopulations, ”for more informatio... | [
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Populations, ”for more information). The\nuse of community health workers may fa-cilitate the adoption of behavior changesfor diabetes prevention while bridgingbarriers related to social determinants of\nhealth. However, coverage by third-party | [
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health. However, coverage by third-party\npayers remains limited. Counseling by aregistered dietitian nutritionist (RDN) hasbeen shown to help individuals with predi-\nabetes improve eating habits, increase\nphysical activity, and achieve 7 –10% weight\nloss (13,49– 51). Individualized medical nu-\ntrition therapy (see... | [
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trition therapy (see Section 5, “Facilitating\nPositive Health Behaviors and Well-beingto Improve Health Outcomes, ”for more\ndetailed information) is also effective in im-proving glycemia in individuals diagnosedwith prediabetes (26,49). Furthermore, tri-\nals involving medical nutrition therapy for\nadults with predi... | [
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adults with prediabetes found signi ficant\nreductions in weight, waist circumference,and glycemia. Individuals with prediabetes\ncan bene fit from referral to an RDN for\nindividualized medical nutrition therapy\nupon diagnosis and at regular intervalsthroughout their treatment plan (50,52).\nOther health care professio... | [
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Other health care professionals, such as\npharmacists and diabetes care and educa-tion specialists, may be considered for dia-betes prevention efforts (53,54).\nTechnology-assisted programs may ef-\nfectively deliver a DPP-like intervention(55–60). A digital diabetes prevention | [
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program improved cardiovascular risk at4 months but not at 12 months (61).Such technology-assisted programs may\ndeliver content through smartphones,\nweb-based applications, and telehealthand may be an acceptable and ef fica-\ncious option to bridge barriers, particu-\nlarly for individuals with low income and | [
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larly for individuals with low income and\npeople in rural locations; however, notdiabetesjournals.org/care Prevention or Delay of Diabetes S45\n©AmericanDiabetesAssociation | [
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all technology-assisted programs are ef-\nfective (55,62 –64). The CDC Diabetes\nPrevention Recognition Program (DPRP)(cdc.gov/diabetes/prevention/requirements\n-recognition.htm) certi fies technology-\nassisted modalities as effective vehicles\nfor DPP-based interventions; such pro-\ngrams must use an approved curricul... | [
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grams must use an approved curriculum,\ninclude interaction with a coach, and at-\ntain the DPP outcomes of participation,physical activity reporting, and weight\nloss. Health care professionals should con-\nsider referring adults with prediabetes to\ncertified technology-assisted programs.\nLifestyle and Type 1 Diabete... | [
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Lifestyle and Type 1 Diabetes\nProgression\nObservational studies suggest that in\nthose with islet autoantibodies, factorsthat may increase b-cell demand includ-\ning less physical activity (65), higher die-tary glycemic index (66), and total sugarintake (67) are associated with progression\nto clinical diabetes. Simi... | [
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to clinical diabetes. Similar associations\nhave not been seen in the development of\nautoantibodies. In The Environmental\nDeterminants of Diabetes in the Young(TEDDY) longitudinal study, daily minutes\nspent in moderate to vigorous physical\nactivity were associated with a reduced\nrisk of progression to type 1 diabe... | [
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risk of progression to type 1 diabetes in\nc h i l d r e n5t o1 5y e a r so fa g ew i t hm u l t i p l eislet autoantibodies (hazard ratio [HR]\n0.92 [95% CI 0.86 –0.99] per 10-min in-\ncrease; P= 0.021) (65). In the Diabetes\nAutoimmunity Study in the Young (DAISY),\nin children with islet autoantibodies, pro-gression... | [
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with higher dietary glycemic index (HR\n2.20 [95% CI 1.17 –4.15]) and total sugar\nintake (HR 1.75 [95% CI 1.07 –2.85])\n(66,67). In nonobese diabetic mice, an ani-mal model for the development of type 1\ndiabetes, sustained high glucose drinking\nsignifi cantly aggravated islet in flammation | [
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signifi cantly aggravated islet in flammation\nand accelerated the onset of type 1 diabe-tes (68). Lifestyle interventions focusing onsuch factors in those with stage 1 or\nstage 2 type 1 diabetes have not yet\nbeen reported.\nPHARMACOLOGIC\nINTERVENTIONS\nRecommendations\n3.7Metformin for the prevention of\ntype 2 diabe... | [
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type 2 diabetes should be considered\nin adults at high risk of type 2 diabetes,as typi fied by the DPP, especially those\naged 25 –59 years with BMI $35 kg/m\n2,higher fasting plasma glucose (e.g.,\n$110 mg/dL [ $6 mmol/L]), and higher\nA1C (e.g., $6.0% [ $42 mmol/mol]),\nand in individuals with prior gestationaldiabet... | [
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and in individuals with prior gestationaldiabetes mellitus. A\n3.8 Long-term use of metformin\nmay be associated with vitamin B12deficiency; consider periodic assess-\nment of vitamin B12 level in metfor-min-treated individuals, especiallyin those with anemia or peripheral\nneuropathy. B\nBecause weight loss through beh... | [
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neuropathy. B\nBecause weight loss through behavior\nchanges in diet and physical activity canbe dif ficult to maintain long term (9),\npeople at high risk of type 2 diabetes maybenefit from additional support and phar- | [
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macotherapeutic options, if needed. Vari-ous pharmacologic agents used to treatdiabetes have been evaluated for diabetesprevention. Metformin, a-glucosidase in-\nhibitors, incretin receptor agonists (e.g.,\nliraglutide and semaglutide), thiazolidine- | [
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liraglutide and semaglutide), thiazolidine-\ndiones, and insulin have been shownto lower the incidence of diabetes inspeci ficp o p u l a t i o n s( 6 9 –74), whereas\ndiabetes prevention was not seen with\nnateglinide (75).\nIn the DPP, weight loss was an impor-\ntant factor in reducing the risk of progres- | [
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tant factor in reducing the risk of progres-\nsion, with every kilogram of weight lossconferring a 16% reduction in risk of pro-gression over 3.2 years (12). In individuals\nwith previous history of GDM, the risk of | [
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with previous history of GDM, the risk of\ntype 2 diabetes increased by 18% for ev-ery 1 unit BMI above the preconceptionbaseline (76). Several medications evalu-ated for weight loss (e.g., orlistat, phenter-\nmine/topiramate, liraglutide, semaglutide, | [
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mine/topiramate, liraglutide, semaglutide,\nand tirzepatide) have been shown to de-crease the incidence of type 2 diabetes inthose with prediabetes (74,77 –79).\nStudies of other pharmacologic agents\nhave shown some ef ficacy in diabetes\nprevention with valsartan or testosterone(80,81), but no ef ficacy in preventing d... | [
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betes with ramipril or anti-in flammatory\ndrugs (81 –84). Although the Vitamin D\nand Type 2 Diabetes (D2d) prospective\nrandomized controlled trial showed no\nsignifi cant bene fit of vitamin D versus pla-\ncebo on the progression to type 2 diabe-tes in individuals at high risk (85), posthoc analyses and meta-analyses s... | [
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potential bene fiti ns p e c i fic populations\n(85–89). Further research is needed to\ndefine characteristics and clinical indicatorswhere vitamin D supplementation may be\nof bene fit (80).\nNo pharmacologic agent has been ap-\nproved by the U.S. Food and Drug Admin-istration for prevention of type 2 diabetes.\nThe risk ... | [
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The risk versus benefi t of each medication\nin support of person-centered goals must\nbe weighed in addition to cost and burdenof administration.\nMetformin has the most safety data as\na pharmacologic therapy for diabetes pre-vention (90). Metformin was overall lesseffective than lifestyle modifi cation in the | [
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DPP, though group differences attenuatedover time in the DPPOS (10), and metfor-\nmin may be cost-saving over a 10-year\nperiod (36). In the DPP, metformin was as\neffective as lifestyle modi fication in par-\nticipants with BMI $35 kg/m\n2and in\nyounger participants aged 25 –44 years | [
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2and in\nyounger participants aged 25 –44 years\n(4). In individuals with a history of GDMin the DPP, metformin and intensive life-style modi fic a t i o nl e dt oa ne q u i v a l e n t | [
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50% reduction in diabetes risk (91). Bothinterventions remained highly effectiveduring a 10-year follow-up period (92). Bythe time of the 15-year follow-up (DPPOS),exploratory analyses demonstrated that\nparticipants with a higher baseline fasting\nglucose ( $110 mg/dL [ $6m m o l / L ]v s .\n95–109 mg/dL [5.3– 5.9 mmo... | [
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95–109 mg/dL [5.3– 5.9 mmol/L]), those with\nah i g h e rA 1 C( 6 . 0 –6.4% [42 –46 mmol/mol]\nvs.<6.0% [<42 mmol/mol]), and individ-\nuals with a history of GDM (vs. individualswithout a history of GDM) experiencedhigher risk reductions with metformin,\nidentifying subgroups of participants that\nmay bene fit the most ... | [
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may bene fit the most from metformin\n(93). In the Indian Diabetes PreventionProgram (IDPP-1), metformin and lifestyleintervention reduced diabetes risk simi-\nlarly at 30 months; however, the lifestyle\nintervention in IDPP-1 was less intensivethan that in the DPP (94). Based on find-\nings from the DPP, metformin shoul... | [
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ings from the DPP, metformin should be\nr e c o m m e n d e da sa no p t i o nf o rh i g h - r i s k\nindividuals (e.g., younger individuals, thosewith history of GDM, or those with BMI$35 kg/m\n2). A recent Chinese open-label | [
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2). A recent Chinese open-label\nrandomized controlled trial showed thatmetformin combined with standard life-style intervention further reduced the riskof developing diabetes than lifestyle inter-vention alone by /C2417% over 2 years (95). | [
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Periodic assessment of vitamin B12 levelin those taking metformin chronicallyshould be considered to check for possibledeficiency, especially in those with anemia\nor peripheral neuropathy (96,97) (seeSection 9, “Pharmacologic Approaches toS46 Prevention or Delay of Diabetes Diabetes Care Volume 47, Supplement 1, Januar... | [
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©AmericanDiabetesAssociation | [
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Glycemic Treatment, ”for more details).\nThe effect of metformin on vitamin B12 in-\ncreases with time (98), with a higher riskfor vitamin B12 de ficiency ( <150 pmol/L)\nnoted at 4 –5 years. A person who has\nbeen on metformin for more than 4 yearsor is at risk for vitamin B12 de ficiency for | [
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other reasons (e.g., vegan, previousgastric/small bowel surgery) should bem o n i t o r e df o rv i t a m i nB 1 2d e ficiency an-\nnually (99).\nPREVENTION OF VASCULAR\nDISEASE AND MORTALITY\nRecommendations\n3.9 P r e d i a b e t e si sa s s o c i a t e dw i t h\nheightened cardiovascular risk; there-\nfore, screening... | [
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fore, screening for and treatment of\nmodifi able risk factors for cardiovascu-\nlar disease are suggested. B\n3.10 Statin therapy may increase the\nrisk of type 2 diabetes in people at\nhigh risk of developing type 2 diabe-tes. In such individuals, glucose status\nshould be monitored regularly and di-\nabetes preventio... | [
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abetes prevention approaches rein-\nforced. It is not recommended that\nstatins be discontinued for this ad-\nverse effect. B\n3.11 In people with a history of stroke\nand evidence of insulin resistance andprediabetes, pioglitazone may be con-\ns i d e r e dt ol o w e rt h er i s ko fs t r o k eo r\nmyocardial infarcti... | [
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myocardial infarction. However, this\nbenefit needs to be balanced with the\nincreased risk of weight gain, edema,\nand fractures. ALower doses may mit-\nigate the risk of adverse effects butmay be less effective. C\nPeople with prediabetes often have other | [
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0.0348266... |
People with prediabetes often have other\ncardiovascular risk factors, including hy-pertension and dyslipidemia (100), andare at increased risk for cardiovasculardisease (101,102). Evaluation for tobaccouse and referral for tobacco cessationshould be part of routine care for those\nat risk for diabetes. Of note, the ye... | [
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at risk for diabetes. Of note, the years\nimmediately following smoking cessationmay represent a time of increased riskfor diabetes (103 –105), and individuals | [
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should be monitored for diabetes devel-opment and receive evidence-basedlifestyle behavior change for diabetesprevention described in this section. SeeSection 5, “Facilitating Positive Health\nBehaviors and Well-being to ImproveHealth Outcomes, ”for more detailedinformation. The lifestyle interventions\nfor weight loss... | [
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for weight loss in study populations at\nrisk for type 2 diabetes have shown a re-duction in cardiovascular risk factors and\nthe need for medications used to treat\nthese cardiovascular risk factors (106,107).The lifestyle intervention in the Da Qingstudy was associated with lowering car-\ndiovascular disease and mort... | [
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diovascular disease and mortality at 23 and\n30 years of observational follow-up (6,8).Treatment goals and therapies for hyper-\ntension and dyslipidemia in the primary\nand secondary prevention of cardiovas-cular disease for people with prediabetes\nshould be based on their level of cardio- | [
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should be based on their level of cardio-\nvascular risk. Increased vigilance is war-ranted to identify and treat these andother cardiovascular diseases risk factors\n(108). Statin use increases risk of diabetes\n(109–113). In the DPP, statin use was as-\nsociated with greater diabetes risk irre-\nspective of the treat... | [
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spective of the treatment group (pooled\nHR [95% CI] for incident diabetes 1.36[1.17 –1.58]) (111). In trials of primary\nand secondary prevention of cardiovas-\ncular disease, cardiovascular and mortal-\nity bene fits of statin therapy exceed the\nrisk of diabetes (114,115), suggesting a\nfavorable benefi t-to-harm bala... | [
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favorable benefi t-to-harm balance with\nstatin therapy. Hence, discontinuation of\nstatins is not recommended in this popu-l a t i o nd u et oc o n c e r n so fd i a b e t e sr i s k .\nCardiovascular outcome trials in people\nwithout diabetes also inform risk reduc-tion potential in people without diabetesat increased... | [
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tion 10, “Cardiovascular Disease and Risk\nManagement, ”for more details). The IRIS\n(Insulin Resistance Intervention after Stroke)\ntrial of people with a recent ( <6m o n t h s )\nstroke or transient ischemic attack, withoutdiabetes but with insulin resistance (as de-fined by a HOMA of insulin resistance index\nof$3.0... | [
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of$3.0), evaluated pioglitazone (target\ndose of 45 mg daily) compared with pla-cebo. At 4.8 years, the risk of stroke ormyocardial infarction, as well as the risk\nof diabetes, was lower in the pioglitazone\ng r o u pt h a nw i t hp l a c e b o ;w e i g h tg a i n ,edema, and fractures were higher in the\npioglitazone... | [
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pioglitazone treatment group (116 –119).\nLower doses may mitigate the adverse ef-\nfects but may also be less effective (120).\nPERSON-CENTERED CARE GOALS\nRecommendations\n3.12 In adults with overweight or obe-\nsity at high risk of type 2 diabetes,\ncare goals should include weight lossand maintenance, minimizing th... | [
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gression of hyperglycemia, and atten-\ntion to cardiovascular risk. B\n3.13 Pharmacotherapy (e.g., for weight\nmanagement, minimizing the progres-\nsion of hyperglycemia, and cardiovascu-lar risk reduction) may be considered to\nsupport person-centered care goals. B\n3.14 More intensive preventive ap-\nproaches should ... | [
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proaches should be considered in indi-\nviduals who are at particularly highrisk of progression to diabetes, includ-ing individuals with BMI $35 kg/m\n2,\nthose at higher glucose levels (e.g.,fasting plasma glucose 110 –125 mg/dL\n[6.1–6.9 mmol/L], 2– h postchallenge glu-\ncose 173– 199 mg/dL [9.6 –11.0 mmol/L],\nand A... | [
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0.02975698560476303,
-0.06166175380349159,
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and A1C $6.0% [ $42 mmol/mol]),\nand individuals with a history of ges-tational diabetes mellitus. A\nIndividualized risk-to-bene fit ratio should\nbe considered in screening, intervention,\nand monitoring to lower the risk of type 2diabetes and associated comorbidities.\nMultiple factors, including age, BMI, and\nother... | [
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0.04803004115819931,
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0.08287186920642853,
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0.004943310748785734,
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0.0161... |
other comorbidities, may in fluence the\nrisk of progression to diabetes and lifetimerisk of complications (121,122). Prediabe-\ntes is associated with increased cardiovas-\ncular disease and mortality (102), whichemphasizes the importance of attendingto cardiovascular risk in this population.\nIn the DPP, which enrolle... | [
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0.040434058755636215,
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In the DPP, which enrolled high-risk indi-\nviduals with IGT, elevated fasting glucose,\nand elevated BMI, the crude incidence of\ndiabetes within the placebo group was11 cases per 100 person-years, with a cu-mulative 3-year incidence of diabetes of29% (4). Characteristics of individuals in\nthe DPP/DPPOS who were at p... | [
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0.01038302481174469,
-0.07750716805458069,
-0.045... |
the DPP/DPPOS who were at particularly\nhigh risk of progression to diabetes (crudeincidence of diabetes 14 –22 cases per 100\nperson-years) included BMI $35 kg/m\n2,\nhigher glucose levels (e.g., fasting plasma\nglucose 110– 125 mg/dL [6– 6.9 mmol/L],\n2–h postchallenge glucose 173 –199 mg/dL\n[9.6–11.0 mmol/L], and A... | [
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[9.6–11.0 mmol/L], and A1C $6.0%\n[$42 mmol/mol]), and a history of GDM\n(4,91,92). In contrast, in the community-based Atherosclerosis Risk in Communi-\nties (ARIC) study, observational follow-upof adults with mean age 75 years withlaboratory evidence of prediabetes(based on A1C 5.7 –6.4% [39 –47 mmol/mol]\nand/or fas... | [
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and/or fasting glucose 100 –125 mg/dL\n[5.6–6.9 mmol/L]), but not meeting speci fic\nBMI criteria, found lower progression todiabetesjournals.org/care Prevention or Delay of Diabetes S47\n©AmericanDiabetesAssociation | [
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0.050172679126262665,
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0.009485636837780476,
0.018048886209726334,
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... |
diabetes over 6 years: 9% of those with\nA1C-de fin e dp r e d i a b e t e s ,8 %w i t hI F G( 1 2 2 ) .\nThus, it is important to individualize the\nrisk-to-bene fit ratio of intervention and\nconsider person-centered goals. Risk mod-els have generally found higher bene fito f | [
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0.02868935838341713,
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0.0298426803201437,
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-0.02062773... |
the intervention in those at highest risk( 1 2 ) .D i a b e t e sp r e v e n t i o nt r i a l sa n do b s e r -\nvational studies highlight key principlesthat may guide person-centered goals. In\nthe DPP, which enrolled a high-risk popu-\nlation meeting criteria for overweight orobesity, weight loss was an important me... | [
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-... |
diator of diabetes prevention or delay,\nwith greater metabolic bene fit seen with\ngreater weight loss (12,123). In the DPP/\nDPPOS, progression to diabetes, duration\nof diabetes, and mean level of glycemia\nwere important determinants of the de-\nvelopment of microvascular complications(10). Achieving normal glucose ... | [
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even once, during the DPP was associated\nwith a lower risk of diabetes and lowerrisk of microvascular complications (124).\nObservational follow-up of the Da Qing\nstudy also showed that regression fromIGT to normal glucose tolerance or re-\nmaining with IGT rather than progressing\nto type 2 diabetes at the end of th... | [
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0.02578521892428398,
0.08354025334119797,
-0.04106748476624489,
0.02460745... |
to type 2 diabetes at the end of the\n6-year intervention trial resulted in signi fi-\ncantly lower risk of cardiovascular disease\nand microvascular disease over 30 years\n(125).\nPharmacotherapy for weight manage-\nment (see Section 8, “Obesity and Weight\nManagement for the Prevention andTreatment of Type 2 Diabetes,... | [
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details), minimizing the progression of hy-\nperglycemia (see Section 9, “Pharmacologic\nApproaches to Glycemic Treatment, ”for\nmore details), and cardiovascular risk re-\nduction (see Section 10, “Cardiovascular\nDisease and Risk Management, ”for more\ndetails) can be considered to support indi-vidualized person-cent... | [
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intensive preventive approaches consideredin individuals at high risk of progression.\nPHARMACOLOGIC\nINTERVENTIONS TO DELAYSYMPTOMATIC TYPE 1 DIABETES\nRecommendation\n3.15 Teplizumab-mzwv infusion to de-\nlay the onset of symptomatic type 1\ndiabetes (stage 3) should be considered inselected individuals aged $8y e a ... | [
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0.12106487154960632,
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0.01636672392487526,
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0.019892876967787743,
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-0.016... |
stage 2 type 1 diabetes. Managementshould be in a specialized setting withappropriately trained personnel. BTeplizumab has been approved to delay\nthe onset of stage 3 type 1 diabetes in\npeople 8 years of age and older with\nstage 2 type 1 diabetes based in part on\nthe results of a single trial in relatives of\npeopl... | [
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0.0007940117502585053,
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0.... |
people with type 1 diabetes (126). In\nthis study, 44 individuals were random-\nized to a 14-day course of teplizumab\nand 32 to placebo. The median time tostage 3 type 1 diabetes diagnosis was\n48.4 months in the teplizumab group and\n24.4 months in the placebo group. Type 1\ndiabetes was diagnosed in 19 (43%) of | [
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0.0634278953075409,
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diabetes was diagnosed in 19 (43%) of\nparticipants who received teplizumab and\n23 (72%) of those who received placebo\n(HR 0.41 [95% CI 0.22 –0.78]). In prespeci-\nfied analyses, the presence of HLA-DR4,\nabsence of HLA-DR3, and absence of anti –\nzinc transporter 8 antibody predicted re-\nsponse to teplizumab (HR 0.2... | [
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0.0304... |
sponse to teplizumab (HR 0.20 [95% CI\n0.09–0.45], 0.18 [0.07 –0.45], and [0.07\n[0.02 to 0.26], respectively). The mostcommon adverse reactions were transient\nlymphopenia (73%) followed by rash\n(36%).\nNumerous clinical studies are being\nconducted to test methods for preventing\nor delaying the onset of stage 3 typ... | [
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or delaying the onset of stage 3 type 1 di-\nabetes in those with evidence of autoim-\nmunity without symptoms or for delaying\nloss of insulin secretory capacity after on-\nset of stage 3, some with promising re-\nsults (see ClinicalTrials.gov and TrialNet\n.org).\nReferences\n1. Ziegler AG, Rewers M, Simell O, et al. | [
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.org).\nReferences\n1. Ziegler AG, Rewers M, Simell O, et al.\nSeroconversion to multiple islet autoantibodies\nand risk of progression to diabetes in children.\nJAMA 2013;309:2473– 2479\n2. Steck A, Dong F, Taki I, et al. Continuousglucose monitoring predicts progression to diabetes\nin autoantibody-positive children.... | [
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in autoantibody-positive children. J Clin Endocrinol\nMetab 2019;104:3337 –3344\n3. Ylescupidez A, Speake C, Pietropaolo SL, et al.OGTT metrics surpass continuous glucose\nmonitoring data for T1D prediction in multiple-\nautoantibody-positive individuals [published\ncorrection appears in J Clin Endocrinol Metab | [
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correction appears in J Clin Endocrinol Metab\n2023;dgad574]. J Clin Endocrinol Metab 2023;\ndgad472\n4. Knowler WC, Barrett-Connor E, Fowler SE,\net al.; Diabetes Prevention Program Research\nGroup. Reduction in the incidence of type 2\ndiabetes with lifestyle intervention or metformin.\nN Engl J Med 2002;346:393– 403 | [
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