A ‘perspective’ article reviews data from several studies that show the efficacy of medical treatments aimed at preventing type 2 diabetes (NEJM 2012; 367: 1177-79).
The Diabetes Prevention Program (DPP) was a comparative effectiveness trial of 3234 overweight or obese adults with impaired glucose tolerance (prediabetes). Findings from this study (published in 2002) showed that lifestyle intervention (attempts at weight loss through diet and exercise) reduced conversion to diabetes by 58% over 3 years, whereas metformin reduced this conversion by 31% over 2 years. Lifestyle intervention worked best in patients ≥ 60 years.
Subsequently, 88% of these subjects were enrolled in the 10-year outcome study (DPPOS). The lifestyle intervention group had a 31% 10-year reduction in diabetes compared with 18% for metformin.
The editorial points out that there have been efforts to expand these results across the country through CDC-sponsored programs in cooperation with the YMCA and UnitedHealth.
Potential roadblocks remain:
- Most payers do not cover these preventive services.
- US Preventive Services Task Force (USPSTF) has not issued a recommendation on these services. this affects both public and private insurance coverage.
- Metformin which may be useful in younger populations does not have a specific indication for diabetes prevention from the FDA (off-label use only).
Whether prevention is ‘worth a pound of cure’ may be hard to discern with prediabetes. Since the peak incidence of diabetes is between 50 and 60 years and complications often emerge more than a decade later, the benefits of preventing diabetes may not be fully apparent for quite a long time.
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