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. Several clinical trials have shown that weight loss is associated with delayed or decreased onset of diabetes in high-risk adults. 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. [ ] 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. [ ] [ ] Lifestyle change and/or metformin are preferred for most patients. More aggressive multi-agent pharmacologic approaches remain controversial. Screening for prediabetes and cardiovascular risk reduction appropriate to the needs of the individual are also very important.
Although the risk of macrovascular complications can be reduced by over 50% using effective multifactorial interventions, 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. More evidence indicates that sodium-glucose co-transporter 2 (SGLT2) and glucagon-like peptide-1 (GLP-1) therapy can play a significant role in reducing future risk in individuals with established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease comorbidities, and use of one these agents should be strongly considered if not contraindicated in the secondary prevention of macrovascular complications.
Other preventive measures include:
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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