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Healthy eating habits early in life may be best strategy to prevent diabetes
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Other than weight loss and additional aspects of intensive lifestyle modification, the restoration of normal glucose regulation in people with prediabetes may be attained by insulin secretion and other biological processes maintained at a younger age.
Researchers assessed the effect of baseline characteristics, weight change, intensive lifestyle modification and metformin use on regression from prediabetes to the lowest-risk state of normal glucose regulation in 3,234 participants included in the Diabetes Prevention Program.
Participants were assigned to one of three groups: intensive lifestyle modification, 850-mg metformin twice-daily in combination with standard lifestyle recommendations or placebo twice-daily in combination with standard lifestyle recommendations.
Predictors for regression to normal glucose regulation were lower baseline fasting glucose (P<.01), two-hour glucose (P<.01), greater weight loss (P<.01), younger age (P<.01) and greater insulin secretion (P=.04).
Men with greater insulin sensitivity, higher fasting glucose and lower two-hour glucose were predictors for regression to isolated impaired fasting glucose.
Predictors for regression to isolated impaired glucose tolerance were women with greater insulin secretion as well as lower fasting and higher two-hour glucose. In addition, metformin and intensive lifestyle modification were associated with regression to isolated IGT in patients in the IFG/IGT group.
“Establishing healthy habits early in life, before age-related changes occur, is most likely the best strategy for diabetes prevention,” the researchers wrote. – by Jennifer Southall
Perreault L. Diabetes Care. 2009;32:1583-1588.
Diabetes does not develop in the absence of a decreased ability to produce insulin. In this study, lowering insulin resistance with lifestyle modification did help regression toward normal glucose tolerance but this was not as effective as maintenance or improvement of beta cell function. Therefore, future studies of prevention for type 2 diabetes should concentrate on medications that improve beta cell function, for example, thiazolidinediones, incretin mimetics and perhaps proton pump blockers which increase gastrin levels.
– David Bell, MD
Endocrine Today Editorial Board member