[Is type-2 diabetes mellitus preventable?]

György Jermendy
Orvosi Hetilap 2003 September 28, 144 (39): 1909-17
The public health burden of type 2 diabetes mellitus has been dramatically increased worldwide. Not only its prevalence rate at present but the increase of its incidence in the near future can create a global health problem. The rapid increase of the total number of newly diagnosed diabetic patients proved to be associated with the increasing prevalence rate of obesity. The metabolic syndrome and type 2 diabetes can contribute to accelerated atherosclerosis and, therefore, the target organ damages can carry a serious problem for the individuals and also for the whole society. It is obvious, that the primary prevention of type 2 diabetes mellitus is of great importance. There is now substantial evidence that type 2 diabetes can be prevented or delayed by lifestyle interventions, i.e. diet and exercise should be the first choice in order to avoid weight gain when preventing diabetes. Pharmacological intervention should not be routinely used to prevent diabetes although results of large clinical trials with metformin and acarbose in subjects with impaired glucose tolerance are available. It is noteworthy that a decrease in the number of newly diagnosed diabetes was observed in prospective, double blind clinical studies evaluating the effect of new antihypertensive drugs (captopril, ramipril, lisinopril, nifedipine GITS, amlodipine, losartan) or lipid-lowering agents (pravastatin) on the cardiovascular morbidity and mortality in high risk patients. In these studies the relative risk reduction of newly diagnosed diabetes was evaluated in comparison to placebo or other drugs in a subgroup of non-diabetic patients at baseline. In addition, the incidence of newly diagnosed type 2 diabetes decreased parallel with weight loss in clinical trials with orlistat, an anti-obesity drug. Although new results were provided by evidence based clinical trials a lot of questions remained to be solved. Further research is necessary to understand better how to facilitate effective primary prevention of type 2 diabetes. Further data are needed to evaluate the clinical significance of currently used antidiabetic drugs and, in addition, the possible role of other drugs (antihypertensives, lipid lowering agents, anti-obesity drugs) should also be investigated in order to identify the optimal primary prevention policy of type 2 diabetes.

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