Primary prevention

Lifestyle factors (obesity, physical inactivity, and stress) seem to be the main drivers of the current diabetes epidemic. With aggressive prevention of obesity in all age groups, type 2 diabetes is potentially preventable.[29][30] Several clinical trials have shown that weight loss is associated with delayed or decreased onset of diabetes in high-risk adults.[14][23][24][25][31][32] Progression to diabetes from pre-diabetic states can be reduced by 50% over 3 to 4 years through modest weight loss (7% of body weight) using diet and regular physical activity.[23] [ Cochrane Clinical Answers logo ] In addition, several pharmacological agents, including metformin, alpha-glucosidase inhibitors, orlistat, glucagon-like peptide 1 (GLP-1) receptor agonists, and thiazolidinediones, have been shown to reduce progression from pre-diabetes to diabetes.[2][26][33][34][35] Lifestyle change and/or metformin are preferred for most patients.[36][37][38][39] More aggressive multi-agent pharmacological approaches remain controversial.[40] Screening for pre-diabetes and cardiovascular risk reduction appropriate to the needs of the individual are also very important.[27][41][42]

Secondary prevention

Although the risk of macrovascular complications can be reduced by over 50% using effective multifactorial interventions,[200] a US national survey found more than half of outpatients over age 50 years with diabetes and hypertension did not receive an antiplatelet agent, statin therapy, or ACE inhibitor/angiotensin-II receptor antagonist.[201]

Other preventative measures include:[2]

  • Annual influenza immunisations

  • Vaccination against pneumococcal disease

  • Hepatitis B vaccination for unvaccinated diabetic adults aged 19 to 59 years; considered for unvaccinated diabetic adults aged 60 years and older

  • Regular dental care

  • Tailored diabetes education.

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