We can change the natural history of type 2 diabetes

Diabetes Care. 2014 Oct;37(10):2668-76. doi: 10.2337/dc14-0817.

Abstract

As diabetes develops, we currently waste the first ∼10 years of the natural history. If we found prediabetes and early diabetes when they first presented and treated them more effectively, we could prevent or delay the progression of hyperglycemia and the development of complications. Evidence for this comes from trials where lifestyle change and/or glucose-lowering medications decreased progression from prediabetes to diabetes. After withdrawal of these interventions, there was no "catch-up"-cumulative development of diabetes in the previously treated groups remained less than in control subjects. Moreover, achieving normal glucose levels even transiently during the trials was associated with a substantial reduction in subsequent development of diabetes. These findings indicate that we can change the natural history through routine screening to find prediabetes and early diabetes, combined with management aimed to keep glucose levels as close to normal as possible, without hypoglycemia. We should also test the hypothesis with a randomized controlled trial.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Diabetes Complications / prevention & control
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Disease Management
  • Disease Progression*
  • Early Diagnosis
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / diagnosis*
  • Hyperglycemia / drug therapy
  • Hypoglycemic Agents / therapeutic use
  • Prediabetic State / blood
  • Prediabetic State / diagnosis*
  • Prediabetic State / drug therapy

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents