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before the development of type 2 diabetes and its complications during which one canintervene, and there are effective approaches delaying type 2 diabetes in those withprediabetes with an A1C 5.7 –6.4% (39– 47 mmol/mol), impaired glucose tolerance | [
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(IGT), or impaired fasting glucose (IFG). The utility of screening with A1C for prediabetes*A complete list of members of the American\nDiabetes Association Professional Practice Committeecan be found at https://doi.org/10.2337/dc24-SINT.\nDuality of interest information for each author is\navailable at https://doi.org... | [
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available at https://doi.org/10.2337/dc24-SDIS.\nSuggested citation: American Diabetes Association\nProfessional Practice Committee. 3. Prevention ordelay of diabetes and associated comorbidities:Standards of Care in Diabetes —2024 .D i a b e t e s\nCare 2024;47(Suppl. 1):S43 –S51 | [
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Care 2024;47(Suppl. 1):S43 –S51\n© 2023 by the American Diabetes Association.Readers may use this article as long as thework is properly cited, the use is educationaland not for pro fit, and the work is not altered. | [
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More information is available at https://www.diabetesjournals.org/journals/pages/license.3. PREVENTION OR DELAY OF DIABETESDiabetes Care Volume 47, Supplement 1, January 2024 S43\n©AmericanDiabetesAssociation | [
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and diabetes may be limited in the pres-\nence of hemoglobinopathies and condi-tions that affect red blood cell turnover.See Section 2, “Diagnosis and Classi fication\nof Diabetes, ”and Section 6, “Glycemic\nGoals and Hypoglycemia, ”for additional\ndetails on the appropriate use and limita-tions of A1C testing. | [
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details on the appropriate use and limita-tions of A1C testing.\nT h r e ed i s t i n c ts t a g e so ft y p e1d i a b e t e s\nhave been defi ned, with symptomatic\ntype 1 diabetes being stage 3 ( Table 2.3 ). | [
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In individuals at risk for development ofclinical type 1 diabetes, younger age ofseroconversion (particularly under age3 years), the total number of diabetes re-lated autoantibodies (1), and the devel-opment of autoantibodies against isletantigen 2 (IA-2) have all been associatedwith more rapid progression to clinicalt... | [
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more rapid progression to clinicaltype 1 diabetes. While continuous glucosemonitoring can predict progression toovert diabetes in children with autoanti- | [
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bodies (2), oral glucose tolerance testing –\nbased metrics are superior in predicting\nprogression compared with continuousglucose monitoring (3). The decision toperform an oral glucose tolerance testmay depend on such factors as eligibilityand interest for stage-speci fict r e a t m e n t s , | [
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participation in clinical research, and avail-ability and burden of testing.\nLIFESTYLE BEHAVIOR CHANGE\nFOR DIABETES PREVENTION\nRecommendations\n3.3Refer adults with overweight or\nobesity at high risk of type 2 diabetes,\nas seen in the Diabetes PreventionProgram (DPP), to an intensive life-\nstyle behavior change p... | [
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style behavior change program to\nachieve and maintain a weight reduc-tion of at least 7% of initial body weightthrough healthy reduced-calorie diet\nand$150 min/week of moderate-\nintensity physical activity. A\n3.4A variety of eating patterns can be\nconsidered to prevent type 2 diabetes\nin individuals with prediabe... | [
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in individuals with prediabetes. B\n3.5Given the cost-effectiveness of lifestyle\nbehavior modi fication programs for diabe-\ntes prevention, such diabetes preventionprograms should be offered to adults athigh risk of type 2 diabetes. ADiabetes\nprevention programs should be covered | [
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prevention programs should be covered\nby third-party payers, and inconsistenciesin access should be addressed. E\n3.6Based on individual preference,\ncertified technology-assisted diabetesprevention programs may be effec-\ntive in preventing type 2 diabetes andshould be considered. B\nThe Diabetes Prevention Program | [
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The Diabetes Prevention Program\nSeveral major randomized controlled tri-\nals, including the Diabetes PreventionProgram (DPP) trial (4), the Finnish Diabe-tes Prevention Study (DPS) (5), and theDa Qing Diabetes Prevention Study (Da\nQing study) (6), demonstrate that life- | [
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Qing study) (6), demonstrate that life-\nstyle/behavioral intervention with an indi-vidualized reduced-calorie meal plan ishighly effective in preventing or delayingtype 2 diabetes and improving other car-diometabolic risk factors (such as blood\npressure, lipids, and in flammation) (7).\nThe strongest evidence for diab... | [
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The strongest evidence for diabetes pre-\nvention in the U.S. comes from the DPPtrial (4). The DPP demonstrated that in-tensive lifestyle intervention could reducethe risk of incident type 2 diabetes by\n58% over 3 years. Follow-up of three large | [
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58% over 3 years. Follow-up of three large\ntrials of lifestyle intervention for diabetesprevention showed sustained reduction inthe risk of progression to type 2 diabetes:39% reduction at 30 years in the Da Qingstudy (8), 43% reduction at 7 years in the\nFinnish DPS (5), and 34% reduction at | [
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Finnish DPS (5), and 34% reduction at\n10 years (9) and 27% reduction at 15 years(10) in the U.S. Diabetes Prevention Pro-gram Outcomes Study (DPPOS).\nThe DPP lifestyle intervention was a\ngoal-based intervention. All participantswere given the same weight loss and\nphysical activity goals, but individualiza- | [
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physical activity goals, but individualiza-\ntion was permitted in the speci ficm e t h -\nods used to achieve the goals (11). Thetwo major goals of the DPP intensive life-style intervention were to achieve andmaintain a minimum of 7% weight loss\nand 150 min of moderate-intensity physi- | [
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and 150 min of moderate-intensity physi-\ncal activity per week, such as brisk walk-ing. Although weight loss was the mostimportant factor in reducing the risk of in-cident diabetes, achieving the behavioralgoal of at least 150 min of physical activ-\nity per week, even without achieving the | [
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ity per week, even without achieving the\nweight loss goal, reduced the incidenceof type 2 diabetes by 44% (12).\nThe 7% weight loss goal was selected\nbecause it was feasible to achieve andmaintain and likely to lessen the risk of de-veloping diabetes (as well as improve other\ncardiometabolic risk factors). Participa... | [
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cardiometabolic risk factors). Participants\nwere encouraged to achieve the $7%\nweight loss during the first 6 months of\nthe intervention. Further analysis suggestshigher bene fit for prevention of diabetes\nwith at least 7 –10% weight loss with life-\nstyle interventions (12). The recommendedpace of weight loss was 1 ... | [
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rie goals were calculated by estimating thedaily calories needed to maintain the par-ticipant ’s initial weight and subtracting\n500– 1,000 calories/day (depending on ini- | [
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500– 1,000 calories/day (depending on ini-\ntial body weight). The initial focus of the di-etary intervention was on reducing totalfat rather than calories. After severalweeks, the concept of calorie balance andthe need to restrict calories and fat was in-troduced (11).\nThe goal for physical activity was se- | [
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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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-0.0664... |
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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0.012537101... |
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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-0.015598380006849766,
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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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0.046... |
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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0.0253546... |
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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0... |
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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-0.04439438506960869,
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0.027221327647566795,
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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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0.04540... |
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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0.00... |
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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0.0... |
©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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0.044... |
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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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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-0.00880182534456253,
0.0178020... |
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... | [
-0.04651306942105293,
0.031085612252354622,
-0.08053182065486908,
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0.10438500344753265,
-0.009866191074252129,
0.0105874... |
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... | [
-0.00394744286313653,
0.019237659871578217,
-0.09785303473472595,
0.006216597277671099,
0.041214197874069214,
0.008659095503389835,
0.08200082182884216,
0.10228566825389862,
-0.00865522213280201,
0.045899465680122375,
-0.00610228581354022,
0.056620948016643524,
-0.023451391607522964,
-0.02... |
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