Diabetes mellitus primary prevention
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Diabetes mellitus Main page |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3] Karol Gema Hernandez, M.D. [4]
Primary Prevention
Type 1 diabetes risk is known to depend upon a genetic predisposition based on HLA types (particularly types DR3 and DR4), an unknown environmental trigger (suspected to be an infection, although none has proven definitive in all cases), and an uncontrolled autoimmune response that attacks the insulin producing beta cells.[1] Some research has suggested that breastfeeding decreased the risk; [2][3] various other nutritional risk factors are being studied, but no firm evidence has been found. [4] Giving children 2000 IU of Vitamin D during their first year of life is associated with reduced risk of type 1 diabetes. [5]
Type 2 diabetes risk can be reduced in many cases by making changes in diet and increasing physical activity.[6][7] The American Diabetes Association (ADA) recommends maintaining a healthy weight, getting at least 2½ hours of exercise per week (a brisk sustained walk appears sufficient), having a modest fat intake, and eating a good amount of fiber and whole grains. The ADA does not recommend alcohol consumption as a preventative, but it is interesting to note that moderate alcohol intake may reduce the risk (though heavy consumption clearly increases damage to body systems significantly). There is inadequate evidence that eating foods of low glycemic index is clinically helpful.[8]
Some studies have shown delayed progression to diabetes in predisposed patients through prophylactic use of metformin,[7] rosiglitazone,[9] or valsartan.[10] In patients on hydroxychloroquine for rheumatoid arthritis, incidence of diabetes was reduced by 77%.[11] Breastfeeding might also be associated with the prevention of type 2 of the disease in mothers.[12]
It is possible that adequate copper could help prevent insulin dependant diabetes since it does so for ATZ poisoned mice [13] and copper in drinking water has somewhat of a protective affect [14]. It could be that copper produces its effects through super oxidase dismutase (SOD) because metaloporpherin based superoxide dismutase can prevent or delay the onset of the autoimmune cascade in diabetes, using mice [15]. However, there are sufficient differences in human and animal models to indicate this is only a theory at the present time.
Children with antibodies treated with vitamin B-3 (niacin) had less than half the onset of diabetes incidence in a 7-year time span as the general population and even lower incidence relative to those with antibodies as above, but no vitamin B-3.[16]
2013 American Diabetes Association Standards of Medical Care in Diabetes (DO NOT EDIT)[17]
Prevention/ Delay of Type 2 Diabetes
| "1. Patients with IGT (Level of Evidence: A), IFG (Level of Evidence: E), or an A1C of 5.7–6.4% (Level of Evidence: E) should be referred to an effective ongoing support program tar- geting weight loss of 7% of body weight and increasing physical activity to at least 150 min/week of moderate activity such as walking. " |
| "2. Follow-up counseling appears to be important for success. (Level of Evidence: B)" |
| "3. Based on the cost-effectiveness of diabetes prevention, such programs should be covered by third-party payers. (Level of Evidence: B)" |
| "4.Metformin therapy for prevention of type 2 diabetes may be considered in those with IGT (Level of Evidence: A), IFG (Level of Evidence: E), or an A1C of 5.7–6.4% (Level of Evidence: E), especially for those with BMI .35 kg/m2, aged ,60 years, and women with prior GDM. (Level of Evidence: A)" |
| "5. At least annual monitoring for the de- velopment of diabetes in those with prediabetes is suggested. (Level of Evidence: E)" |
| "6. Screening for and treatment of modifi- able risk factors for CVD is suggested. (Level of Evidence: B)" |
Recommendations for Primary Prevention of Type 2 Diabetes
| "1. Among individuals at high risk for developing type 2 diabetes, structured programs that emphasize lifestyle changes that include moderate weight loss (7% body weight) and regular physical activity (150 min/week), with dietary strategies including reduced calories and reduced intake of dietary fat, can reduce the risk for developing diabetes and are therefore recommended. (Level of Evidence: A)" |
| "2. Individuals at risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intake). (Level of Evidence: B)" |
| "3.Individuals at risk for type 2 diabetes should be encouraged to limit their intake of sugar-sweetened beverages (SSBs). (Level of Evidence: B)" |
Children and Adolescents
| "1. As is the case for all children, children with diabetes or prediabetes should be encouraged to engage in at least 60 min of physical activity each day. (Level of Evidence: B)" |
Children and Adolescents Glycemic Control
| "1. Consider age when setting glycemic goals in children and adolescents with type 1 diabetes. (Level of Evidence: E)" |
References
- ↑ Daneman D (2006). "Type 1 diabetes". Lancet. 367 (9513): 847–58. PMID 16530579.
- ↑ Borch-Johnsen K, Joner G, Mandrup-Poulsen T, Christy M, Zachau-Christiansen B, Kastrup K, Nerup J (1984). "Relation between breast-feeding and incidence rates of insulin-dependent diabetes mellitus. A hypothesis". Lancet. 2 (8411): 1083–6. PMID 6150150.
- ↑ Naim Shehadeh, Raanan Shamir, Moshe Berant, Amos Etzioni (2001). "Insulin in human milk and the prevention of type 1 diabetes". Pediatric Diabetes. 2 (4): 175–177.
- ↑ Virtanen S, Knip M (2003). "Nutritional risk predictors of beta cell autoimmunity and type 1 diabetes at a young age". Am J Clin Nutr. 78 (6): 1053–67. PMID 14668264.
- ↑ Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM (2001). "Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study". Lancet. PMID 11705562.
- ↑ Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson J, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle T, Uusitupa M, Tuomilehto J (2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study". Lancet. 368 (9548): 1673–9. PMID 17098085.
- ↑ 7.0 7.1 Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E, Nathan D (2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin". N Engl J Med. 346 (6): 393–403. PMID 11832527.
- ↑ Bantle JP, Wylie-Rosett J, Albright AL; et al. (2006). "Nutrition recommendations and interventions for diabetes--2006: a position statement of the American Diabetes Association". Diabetes Care. 29 (9): 2140–57. doi:10.2337/dc06-9914. PMID 16936169.
- ↑ Gerstein H, Yusuf S, Bosch J, Pogue J, Sheridan P, Dinccag N, Hanefeld M, Hoogwerf B, Laakso M, Mohan V, Shaw J, Zinman B, Holman R (2006). "Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial". Lancet. 368 (9541): 1096–105. PMID 16997664.
- ↑ Kjeldsen SE, Julius S, Mancia G, McInnes GT, Hua T, Weber MA, Coca A, Ekman S, Girerd X, Jamerson K, Larochelle P, Macdonald TM, Schmieder RE, Schork MA, Stolt P, Viskoper R, Widimsky J, Zanchetti A; for the VALUE Trial Investigators (2006). "Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: the VALUE trial". J Hypertens. 24 (7): 1405–1412. PMID 16794491.
- ↑ Wasko MC, Hubert HB, Lingala VB; et al. (2007). "Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis". JAMA. 298 (2): 187–93. doi:10.1001/jama.298.2.187. PMID 17622600.
- ↑ Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB (2005). "Duration of lactation and incidence of type 2 diabetes". JAMA. 294 (20): 2601&ndash, 10. PMID 16304074.
- ↑ Sitasawad S, Deshpande M, Katdare M, Tirth S, Parab P. (2001) Beneficial effect of supplementation with copper sulfate on STZ diabetic mice (IDDM). Diabetes Res Clin Pract May;52(2):77-84.
- ↑ Zhao HX, Mold MD, Stenhouse EA, Bird SC, Wright DE, Demaine AG, Millward BA. (2001) Drinking water composition and childhood-onset Type 1 diabetes mellitus in Devon and Cornwall, England. Diabetic Med 18(9) p709-717.This article modified in November 2007.
- ↑ Haskins K, et al (2003) "Immunology of diabetes II. Pathogenesis from mouse to man." Ann. N.Y. Academy of Sciences 1005: 43. doi. 10.1196/annals.1288.006.
- ↑ Elliott RB Pilcher CC Fergusson DM Stewart AW 1996 A population based strategy to prevent insulin-dependent diabetes using nicotinamide. J Pediatr Endocrinol Metab. 1996 Sep-Oct;9(5):501-9.
- ↑ American Diabetes Association (2013). "Standards of medical care in diabetes--2013". Diabetes Care. 36 Suppl 1: S11–66. doi:10.2337/dc13-S011. PMC 3537269. PMID 23264422.