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.[24][25] Several clinical trials have shown that weight loss is associated with delayed or decreased onset of diabetes in high-risk adults.[15][18][19][20][26][27] Progression to diabetes from prediabetic 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.[18] [ Cochrane Clinical Answers logo ] In addition, several pharmacologic agents, including metformin, alpha-glucosidase inhibitors, orlistat, glucagon-like peptide 1 (GLP-1) receptor agonists, and thiazolidinediones, have been shown to reduce progression from prediabetes to diabetes.[2][21][28][29][30] [ Cochrane Clinical Answers logo ] [ Cochrane Clinical Answers logo ] Lifestyle change and/or metformin are preferred for most patients.[31][32][33][34] More aggressive multi-agent pharmacologic approaches remain controversial.[35] Screening for prediabetes and cardiovascular risk reduction appropriate to the needs of the individual are also very important.[22][36][37]

Secondary prevention

Although the risk of macrovascular complications can be reduced by over 50% using effective multifactorial interventions,[195] 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.[196]

Other preventive measures include:[2]

  • Annual influenza immunizations

  • Vaccination against pneumococcal disease

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

  • Regular dental care

  • Tailored diabetes education.

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