Факторы образа жизни (ожирение, отсутствие физической активности и стресс), скорее всего, являются главными триггерами вспышек диабета в настоящее время. Интенсивное принятие профилактических мер против ожирения во всех возрастных группах потенциально предупреждает развитие сахарного диабета 2-го типа.[29]Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019 May;42(5):731-54.
https://care.diabetesjournals.org/content/42/5/731.long
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[30]LeBlanc EL, Patnode CD, Webber EM, et al; Agency for Healthcare Research and Quality (US). Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: an updated systematic review for the U.S. Preventive Services Task Force. Sep 2018 [internet publication].
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Некоторые клинические исследования продемонстрировали, что потеря веса связана с задержкой или сокращением развития диабета у взрослых с высоким риском.[14]Hemmingsen B, Gimenez-Perez G, Mauricio D, et al. Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database Syst Rev. 2017 Dec 4;(12):CD003054.
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http://www.ncbi.nlm.nih.gov/pubmed/29205264?tool=bestpractice.com
[23]Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.
https://www.nejm.org/doi/10.1056/NEJMoa012512
http://www.ncbi.nlm.nih.gov/pubmed/11832527?tool=bestpractice.com
[24]Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. Diabetes Care. 1997 Apr;20(4):537-44.
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[25]Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001 May 3;344(18):1343-50.
https://www.nejm.org/doi/full/10.1056/NEJM200105033441801
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[31]Knowler WC, Fowler SE, Hamman RF, et al; Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86.
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[32]Balk EM, Earley A, Raman G, et al. Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force. Ann Intern Med. 2015 Sep 15;163(6):437-51.
https://annals.org/aim/fullarticle/2395729/combined-diet-physical-activity-promotion-programs-prevent-type-2-diabetes
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Прогрессирование преддиабетического состояния в диабет может быть снижено на 50% в течение от 3 до 4 лет при умеренной потере веса (7% массы тела) с помощью диеты и регулярной физической нагрузки.[23]Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.
https://www.nejm.org/doi/10.1056/NEJMoa012512
http://www.ncbi.nlm.nih.gov/pubmed/11832527?tool=bestpractice.com
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What are the effects of diet, physical activity, or both in people at increased risk of developing type 2 diabetes mellitus?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1974/fullПоказать ответ Кроме того, некоторые лекарственные средства, включая метформин, ингибиторы альфа-глюкозидазы, орлистат, антагонисты рецепторов глюкагоноподобного пептида 1 (GLP-1) и производные тиазолидиндиона продемонстрировали способность к снижению прогрессирования преддиабета в диабет.[2]American Diabetes Association. Standards of medical care in diabetes - 2019. Diabetes Care. 2019;42(Suppl 1):S1-193.
https://care.diabetesjournals.org/content/42/Supplement_1
[26]Gerstein HC, Yusuf S, Bosch J, et al; DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet. 2006 Sep 23;368(9541):1096-105.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69420-8/fulltext
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[33]Apolzan JW, Venditti EM, Edelstein SL, et al. Long-term weight loss with metformin or lifestyle intervention in the Diabetes Prevention Program Outcomes Study. Ann Intern Med. 2019 May 21;170(10):682-90.
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[34]Moelands SV, Lucassen PL, Akkermans RP, et al. Alpha-glucosidase inhibitors for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database Syst Rev. 2018 Dec 28;(12):CD005061.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005061.pub3/full
http://www.ncbi.nlm.nih.gov/pubmed/30592787?tool=bestpractice.com
[35]Hemmingsen B, Sonne DP, Metzendorf MI, et al. Dipeptidyl-peptidase (DPP)-4 inhibitors and glucagon-like peptide (GLP)-1 analogues for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk for the development of type 2 diabetes mellitus. Cochrane Database Syst Rev. 2017;(5):CD012204.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012204.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/28489279?tool=bestpractice.com
В большинстве случаев отдают предпочтение изменению образа жизни и/или применению метформина.[36]Roberts S, Barry E, Craig D, et al. Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes. BMJ Open. 2017 Nov 15;7(11):e017184.
https://bmjopen.bmj.com/content/7/11/e017184.long
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[37]Haw JS, Galaviz KI, Straus AN, et al. Long-term sustainability of diabetes prevention approaches: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med. 2017 Dec 1;177(12):1808-17.
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[38]Herman WH, Pan Q, Edelstein SL, et al; Diabetes Prevention Program Research Group. Impact of lifestyle and metformin interventions on the risk of progression to diabetes and regression to normal glucose regulation in overweight or obese people with impaired glucose regulation. Diabetes Care. 2017 Dec;40(12):1668-77.
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[39]Galaviz KI, Weber MB, Straus A, et al. Global diabetes prevention interventions: a systematic review and network meta-analysis of the real-world impact on incidence, weight, and glucose. Diabetes Care. 2018 Jul;41(7):1526-34.
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Более агрессивные многокомпонентный фармакологические подходы остаются спорными.[40]Armato JP, DeFronzo RA, Abdul-Ghani M, et al. Successful treatment of prediabetes in clinical practice using physiological assessment (STOP DIABETES). Lancet Diabetes Endocrinol. 2018 Oct;6(10):781-9.
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Для снижения риска преддиабета и сердечно-сосудистых заболеваний, соответствующего индивидуальным потребностям пациента, также важен скрининг.[27]Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Circulation. 2019 Sep 10;140(11):e596-e646.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678
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[41]Cosentino F, Grant PJ, Aboyans V, et al; Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2019 Aug 31 [Epub ahead of print].
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz486/5556890
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[42]Rosenzweig JL, Bakris GL, Berglund LF, et al. Primary prevention of ASCVD and T2DM in patients at metabolic risk: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019 Sep;104(9):3939-85.
https://academic.oup.com/jcem/article/104/9/3939/5540926
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