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Diabetes prevention program research group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
... The progression from prediabetes to diabetes is a complex process shaped by genetic, metabolic, and environmental determinants 20 . In randomized controlled trials (RCTs) conducted across Asia, Europe, and the US, annual progression rates from prediabetes to diabetes in control groups ranged from 5.8% to 18.3% 4,5,21,22 . Notably, the China Da Qing Study reported a cumulative diabetes incidence of 95.9% among individuals with prediabetes over a 30-year follow-up period 23 . ...
... Notably, the China Da Qing Study reported a cumulative diabetes incidence of 95.9% among individuals with prediabetes over a 30-year follow-up period 23 . The US DPP study reported an incidence of diabetes of 11% in the placebo group 22 . The Finnish Diabetes Prevention Study observed a cumulative incidence of diabetes of 23% after 4 years in the control group. ...
... East Asian populations exhibit unique prediabetes subphenotypes, with IGT being more prevalent than IFG, likely due to higher visceral adiposity and insulin resistance despite lower body mass index (BMI) thresholds 45 , although research indicates that race or ethnicity is not a significant predictor of incident diabetes 22,46 . Notably, it has been suggested that in East Asians, insulin resistance is not a risk factor for diabetes progression; instead, reduced insulin secretion predicts diabetes progression, independent of gender, age, and BMI, in contrast to White Europeans 26 . ...
Controlling the epidemic of diabetes is an urgent global healthcare challenge. The low uptake of diabetes prevention programs highlights difficulties in scalability, partly due to the need for intensive face‐to‐face contact and its impact on healthcare resource utilization. In this narrative review, we will summarize the latest evidence in technology‐assisted lifestyle interventions. We will appraise evidence of digital diabetes prevention programs that use internet platforms or text messaging tools to support information delivery, lifestyle coaching, or peer support. We will also discuss the use of wearables, including physical activity trackers and continuous glucose monitoring (CGM) as part of lifestyle intervention. Experience from diabetes highlights the potential for CGM as a motivational tool to promote lifestyle change. The integration of digital data may facilitate earlier detection of prediabetes, sub‐phenotyping, and personalized nutritional predictions. We will highlight major gaps in research and the need for rigorous clinical trials to evaluate the acceptability and cost‐effectiveness of integrating technologies as part of a multicomponent strategy in diabetes prevention.
... The onset of duodenal luminal uptake of glucose typically occurs within minutes of luminal presentation and digestive activity in the brush border region of the small intestine, where the glucosidase and sucrase enzymes are located within the brush border microvillar extensions [3]. Numerous dietary constituents can influence the efficiency of luminal digestion and absorption of monosaccharides, including gums, fibers, minerals, and a plethora of naturally occurring phytochemical components of food that may impede the efficiency of brush border enzymatic actions [6][7][8][9]. Naturally occurring stereospecific inhibitors of starch digestion include a broad family of glucosidase and sucrase inhibitors that act at the level of the luminal brush border to delay enzymatic activity that contributes to the luminal digestion of starches and sugars [7]. Pharmaceutical agents that are modelled after the natural products can also impact the efficiency and activity of the luminal digestive enzymes, effectively delaying the rate of luminal carbohydrate digestion into absorbable monosaccharides and lowering blood glucose concentrations [8,9]. ...
... Naturally occurring stereospecific inhibitors of starch digestion include a broad family of glucosidase and sucrase inhibitors that act at the level of the luminal brush border to delay enzymatic activity that contributes to the luminal digestion of starches and sugars [7]. Pharmaceutical agents that are modelled after the natural products can also impact the efficiency and activity of the luminal digestive enzymes, effectively delaying the rate of luminal carbohydrate digestion into absorbable monosaccharides and lowering blood glucose concentrations [8,9]. As the luminal generation of monosaccharides become decreased, the hormonal result includes an attenuation of insulin release and subsequent alterations in the processes of glucose uptake in peripheral tissues [3,10]. ...
... The concurrent increase in the prevalence of Type 2 diabetes mellites (T2DM) is now among the most common comorbidities of overweight and obese conditions and now impacts up to 1/6 or more of the populations of many communities [1,2,10,14]. Moreover, the economic costs of these stigmata due to lost achievement in the workplace and to the subsequent health and financial issues that necessarily follow their clinical diagnosis are becoming a major burden on available health care resources in many jurisdictions [1,2,8]. Since once an overweight or obese condition has been diagnosed, with or without confirmation of T2DM as a comorbidity, clinical patient management typically continues throughout the remainder of the individual's lifespan [6,13]. ...
The global prevalence of obesity+T2DM is approaching endemic proportions throughout much of Industrialized society, creating a challenge to health care resources, with no easy resolution on the horizon. This study aims to determine the effect of delayed carbohydrate (sucrose) digestion in type 2 diabetes mellites on the activity of glycemic and lipogenic enzyme parameters that directly or indirectly impact on carbohydrate and lipid metabolism and energy deposition. Groups (n=6-8/group, mean BW 264 ± 5g vs 263 ± 4g) of young adult male obese T2DM (diabetic) SHR/Ntul//-cp rats were fed a nutritionally complete USDA-formulated diet containing 54% sucrose (Control, CON) or the same diet with 150 mg of the luminal α-glucosidase inhibitor miglitol (MIG) for up to 8 weeks. Standardized analytical procedures established in our laboratory were utilized to quantify the findings. All animals demonstrated profound (4+) glycosuria by 8-10 weeks of age to confirm T2DM. Body Weight Gain (BWG), relative adiposity and glycosuria were elevated in CON animals. Measures of Oral Glucose Tolerance (OGT, 2.50 g glucose/kg BW, via gavage), AUC for glucose and insulin response to OGT and glycated hemoglobin (HbA1c) were elevated in controls and decreased by ~20% after MIG treatment. Hepatic Glucokinase (GK), and lipogenic NADPH-generating enzymes malic enzyme (ME) and glucose-6-phophate dehydrogenase (G6PD) were elevated in the CON and all decreased following MIG treatment. MIG was without effect on percent adiposity in lean rats of both strains or in the obese, non-diabetic LA/Ntul//-cp rats, but adiposity was decreased by ~10% in the obese-T2DM diabetic rats, consistent with the impact on lipogenic enzymes in T2DM. In conclusion, these observations indicate that luminal modulation of carbohydrate digestion can be an effective, cost-effective clinical strategy to improve the magnitude of the elevated glycemic and lipogenic enzymes and their subsequent impact on developing adiposity in the T2DM-prone obese+SHR/Ntul//-cp genetic rat strain, and may be an effective adjunct in clinical management of obesity, hyperlipidemia and T2DM as it occurs in man and animals.
... 6 Landmark clinical trials, including the U.S. Diabetes Prevention Program study, have demonstrated that the medication metformin lowers diabetes incidence by approximately 30% among adults with prediabetes. 7,8 However, prior studies have found low rates of metformin prescriptions for this purpose. [9][10][11][12] This data underscores the public health importance of metformin as an evidence-based option for diabetes prevention, especially among socially disadvantaged adults with prediabetes. ...
... Following clinical guidelines that recommend metformin treatment especially for prediabetic adults aged < 60 years and those with class 2 or 3 obesity-groups that experienced even greater diabetes risk reductions from metformin than the overall prediabetic population-we examined prescription orders in these subgroups. 7,16 ...
... The landmark DPP trial also found that Black adults experienced a greater reduction in diabetes incidence with metformin (i.e., 44%) than those observed in other racial or ethnic groups: i.e., White (24%); Hispanic (31%); American Indian (25%); and Asian (38%). 7 Health equity experts advocate against making clinical guidelines based on race 29 ; and accordingly, ADA does not recommend prioritizing metformin treatment for Black patients with prediabetes. 16 However, our analysis documents unfortunate racial disparities in metformin prescription orders, with the highest rates observed among White FQHC patients. ...
Clinical trials of adults with prediabetes demonstrate that metformin can prevent or delay the risk of developing type 2 diabetes by approximately 30%. The association between socioeconomic disadvantage and elevated diabetes risk underscores the importance of using metformin in this high-risk group.
To examine the prevalence of metformin prescriptions among patients with prediabetes served by federally qualified health centers (FQHCs), the largest national system of primary care clinics in socioeconomically disadvantaged communities.
Retrospective cohort study using 2008–2019 electronic health record data from a national FQHC network.
Patients with prediabetes were identified by the presence of: ≥ 1 diagnosis code; or ≥ 2 glycemic test results in the prediabetes range. We excluded patients with prior metformin prescription orders and those with prior evidence of diabetes by diagnosis code or two glycemic test results in the diabetes range.
We examined metformin prescription orders, overall, and by patient characteristics including age and body mass index (BMI).
A total of 59,232 FQHC patients were found to have prediabetes, of whom 48.4% reported Hispanic ethnicity, 27.2% reported Black race, 22.5% had Medicaid insurance, and 33.1% were uninsured. Within one and five years of prediabetes diagnosis, metformin was prescribed for 3.0% and 6.1% of patients, respectively. In multivariate analyses, increasing BMI was the strongest predictor of metformin prescription orders. Disparities in metformin prescription rates were observed among FQHCs patients from racial minority groups relative to White patients.
Metformin prescriptions for prediabetes are rare among FQHC patients. Prescribing rates were higher among patients with elevated BMI, and lower among patients from racial minority groups. Further research is needed to understand reasons for low metformin use in this population and promote clinical guidelines for diabetes prevention in FQHCs.
... Historically, in 1999, the first double-blind, randomized controlled trial (RCT) that tested metformin in Chinese PwPd was conducted by Li et al. [6], which showed a significant 66% relative risk reduction (RRR) in the conversion rate of frank T2D by metformin compared to placebo, over one year. The largest (n = 3,234) and the longest doubleblind RCT was the US-based Diabetes Prevention Program (US-DPP), an RCT conducted in 2002 by Knowler et al. [7], and a subsequent 10, 15, and 22-year observational follow-up outcome study (DPPOS) [8][9][10]. US-DPP randomized PwPd in a 1:1:1 fashion to either iLSM (target weight loss of at least 7% and 150 min/week of moderate exercise such as brisk walking) or metformin or control. ...
... During the randomized phase of mean 2.8 years of US-DPP, both iLSM and metformin reduced T2D conversion by an RRR of 58% and 31%, respectively, compared to control. However, the incidence of T2D with iLSM was 39% lower than metformin [7]. The subsequent observational 10, 15, and 22-year follow-up of DPPOS [8][9][10] also showed a significant decrease in RRR concerning progression to frank T2D compared to control; however, the quantum of benefit reduced over time in both metformin and iLSM arms ( Fig. 1). ...
... Interestingly, no RCT was used to compare the effectiveness of LSM/iLSM plus metformin vs. metformin alone. The results from all these RCTs conducted are summarized in Table 1 chronologically [6,7,[11][12][13][14][15][16][17]. Briefly, amongst the open-label studies, two RCTs were also conducted in the Indians -a. ...
... The additional bene ts of performing high amounts of MVPA (> 300 min/week) tended to be marginal or plateaued [4][5][6][7] . Additionally, the landmark clinical trials that established the cause-effect relationship between PA and chronic disease prevention and management further justi ed the guideline recommendations [8][9][10][11] . For example, lifestyle modi cations that incorporated 150 min/week of MVPA, comprising a minimum of two supervised sessions per week, resulted in a 58% reduction in diabetes incidence 11 . ...
... Additionally, the landmark clinical trials that established the cause-effect relationship between PA and chronic disease prevention and management further justi ed the guideline recommendations [8][9][10][11] . For example, lifestyle modi cations that incorporated 150 min/week of MVPA, comprising a minimum of two supervised sessions per week, resulted in a 58% reduction in diabetes incidence 11 . ...
Current physical activity guidelines recommend 150–300 minutes per week of moderate-to-vigorous physical activity (MVPA) for health benefits. However, whether this recommended dose applies to brief, sporadic MVPA remains unclear. We analyzed data from 96,065 UK Biobank participants whose MVPA was objectively measured by accelerometers. A machine learning algorithm, trained on ground-truth camera data, was employed to differentiate between sporadic and bouted MVPA. Sporadic MVPA was inversely associated with all-cause mortality and cardiovascular disease incidence in an L-shaped manner, leveling off at 150 minutes per week. Conversely, there was a curvilinear dose-response relationship between bouted MVPA and health outcomes, with no clear threshold. In joint analysis, optimal health benefits were observed in individuals who incorporated both bouted and sporadic MVPA, rather than merely accumulating additional sporadic MVPA beyond 150 minutes. In conclusion, meeting the minimum physical activity recommendation through accumulating brief, sporadic MVPA is supported.
... kg [~5%] over three years in obese pre-diabetes individuals following a low-calorie diet led to a decrease in the annual conversion rate to 2.8% versus 6.0% in the control group. Identical results were also reported in a much larger study, the Diabetes Prevention Trial [29], in which a group of 3,234 obese people on a caloric restriction diet had a mean loss of body weight of ~7% [5-7 kg] after three years. A reduction in the annual conversion rate from pre-diabetes to diabetes of ~50%, i.e., from 11.0% in the control group down to 4.8% in the intervention group, was then registered. ...
... As plasma glucose levels rise or the HbA1c values increase, even if they remain within the pre-diabetes range, the addition of either metformin or pioglitazone to "diet and exercise" plans is warranted. Metformin, at the dose of 500 mg up to 1000 mg twice daily has been demonstrated to prevent T2DM [29]. Metformin inhibits endogenous release of glucose and attenuates the demand for insulin secretion, which tends to extend the pancreatic beta-cell insulin reserve. ...
Natural history and Pre-diabetes – Type-2 diabetes (T2DM) is a chronic disease with various metabolic and hormonal disorders derived from genetic and environmental factors that compromise organs and functional systems. Prevention must be initiated in the pre-diabetes phase aimed at high-risk individuals using aggressive measures to reduce excessive body fat with a concerted effort to improve tissue insulin resistance and to protect residual beta-cell insulin secretion. Healthy nutritional adjustments must include low-calorie and low-simple carbohydrate diets with preference for fresh fruits, vegetables, whole grains, more nuts and vegetable oils, lean meats and fish. Less consumption of animal-derived fat, whole-milk dairy products and red meat, and avoidance of sugared beverages. Regular exercises and daily physical activities are recommended. Pharmacotherapy with either metformin and/or pioglitazone is indicated in pre-diabetes individuals with signs of deterioration in glycemic control. Early T2DM - Once the diagnosis is confirmed, the main goal of therapy shifts and control of hyperglycemia to avoid hospitalization for acid-base and hydro-electrolytic disturbances, acute infections and/or coronary events becomes a top priority. A short trial of insulin therapy or sulfonylurea may be warranted, although these should be rapidly substituted for SGLT2i agents with/without GLP-1 RA. A thorough evaluation of glucosedependent microvascular complications such as retinopathy, nephropathy and neuropathies are mandatory. Measures instituted in pre-diabetes must remain in place and, together with new medications; therapeutic objectives are more likely to be achieved. Late T2DM - As diabetes progresses, efforts to reduce the risk for the development of cardiovascular and renal complications take priority. Dietary recommendations, tailored exercise programs, physical therapy, smoking cessation and promotion of a healthier lifestyle become necessary. A review of anti-atherogenic medications must be implemented. Ultimate objectives in advanced T2DM are to provide quality of life and to help reduce precocious mortality with an extended healthier survival. Keywords: Pre-diabetes; Nutritional assessment; Type-2 diabetes; Antihyperglycemic agents; Multi-drug therapy; Cardiovascular prevention; Diabetes kidney disease; Risk management
... This prompts reflection on OGTT staging and the impact of immunotherapy in adults, who often have risk factors for type 2 diabetes (T2D), such as central obesity (15). Although TN-10 showed that immunotherapy for adults with stage 2 T1D delayed disease progression, their slower rate of progression and the contribution of central adiposity and insulin resistance to T1D risk (8,16,17) raise the possibility that T2D prevention therapies that address these risk factors, including lifestyle modification (18,19), metformin (19), or incretin analogs (20), might be safer and more cost effective than immunotherapy for achieving the ultimate goal of delaying insulin dependence. Future adult prevention trials should account for their lower risk of disease progression and allow use of adjunctive therapies where clinically indicated. ...
... This prompts reflection on OGTT staging and the impact of immunotherapy in adults, who often have risk factors for type 2 diabetes (T2D), such as central obesity (15). Although TN-10 showed that immunotherapy for adults with stage 2 T1D delayed disease progression, their slower rate of progression and the contribution of central adiposity and insulin resistance to T1D risk (8,16,17) raise the possibility that T2D prevention therapies that address these risk factors, including lifestyle modification (18,19), metformin (19), or incretin analogs (20), might be safer and more cost effective than immunotherapy for achieving the ultimate goal of delaying insulin dependence. Future adult prevention trials should account for their lower risk of disease progression and allow use of adjunctive therapies where clinically indicated. ...
OBJECTIVE
Approval of teplizumab as disease-modifying therapy for type 1 diabetes heralds a new therapeutic era. To facilitate prevention trials, we determined if the M120 risk score could enrich for type 1 diabetes risk and define early treatment effects.
RESEARCH DESIGN AND METHODS
M120, based on age, sex, BMI, IA-2 antibody status, HbA1c, blood glucose, and C-peptide 120 min after oral glucose, was determined in TrialNet participants with multiple islet autoantibodies and those who joined the teplizumab prevention trial.
RESULTS
Compared with the oral glucose tolerance test, M120 identified 26% more children at high risk of progression. When applied to data from the teplizumab trial, M120 improved after teplizumab (P = 0.0362) and deteriorated after placebo (P = 0.0489) to reveal a significant treatment effect after 6 months (P < 0.001).
CONCLUSIONS
M120 improves risk stratification and identifies early effects of immunotherapy. It could be applied to increase prevention trial efficiency and guide treatment decisions in the clinic.
... However, those studies do not integrate in their findings the concurrent effects of oral medication or the effects of ageing in these individuals. Other rigorously controlled randomized trials in obese participants (Diabetes Prevention Program [DPP] [21], Look AHEAD [22], U-TURN [23] and PROPEL [24]) show a reduction in cardiometabolic risk factors and medication use when combining physical activity and diet to achieve clinically relevant body weight loss (i.e., > 5%). However, these interventions require a drastic lifestyle change rarely sustained after the experiment is completed [25]. ...
... Some studies show that intensive lifestyle interventions combining diet and exercise can result in clinically meaningful weight loss (body weight loss > 6.5% [21][22][23]). In these studies, individuals reduce obesity-related conditions such as diabetes, hypertension and dyslipidaemia to the point that clinicians de-prescribe some medication. ...
Background
Metabolic syndrome (MetS) is a set of five cardiometabolic risk factors that typically worsen with age. One exercise‐training programme is effective at improving those factors in middle‐aged individuals with MetS. To our knowledge, exercise‐training efficacy as MetS individuals age has not been explored. This study determined the effectiveness of a periodized exercise training programme for individuals with MetS after a follow‐up period of 8 years.
Methods
Forty‐seven individuals with MetS were block‐randomized into an EXERCISE (n = 22, 52 ± 8 years old, 23% women) or a CONTROL group (n = 25, 53 ± 8 years old, 32% women). Both groups received standard health care, including medical counselling and lifestyle advice at least every 6 months, while participants in EXERCISE also underwent a supervised exercise programme. The intervention lasted 8 years and consisted of 4 months per year (November to March) of high‐intensity interval training thrice weekly. At baseline, and after 4 and 8 years of treatment, we assessed body composition, MetS components (i.e., MetS Z score), medication use, cardiorespiratory fitness (CRF; assessed by VO2MAX) and maximal leg cycling power output (WMAX).
Results
Paradoxically, MetS Z score and body weight were reduced after 8 years (subjects aged from 52 to 60 years old) in both groups (time effect p < 0.001 and p = 0.008; time × group interaction p = 0.253 and p = 0.130). However, in those 8 years, the medicine use score increased threefold in CONTROL (137% increase; from 1.7 to 3.9; p < 0.001) while it did not change in EXERCISE (33%; from 2.0 to 2.7; p = 0.066). In 8 years, CRF and WMAX increased in EXERCISE by 14% (3.4 ± 5.6 mL·kg⁻¹·min⁻¹) and 4% (7 ± 37 W) while decreasing in CONTROL by −7% (−1.6 ± 3.4 mL·kg⁻¹·min⁻¹) and −14% (−24 ± 27 W) being different between groups after 4 and 8 years (both time × group interaction p = 0.002). Pearson correlations showed that MetS Z score improvements were significantly associated with increases in medication use score in the CONTROL group (r = 0.491; p = 0.013) and with WMAX enhancement in the EXERCISE group (r = 0.613; p = 0.002).
Conclusions
Our data suggest that annual exercise training has similar clinical efficacy to triple oral medication for the management of MetS in individuals aged 50 to 60 years. The health of individuals with cardiometabolic disorders can be maintained as they age by increasing medication or by participating in an annual intensive exercise programme.
... 4 Characterized by both impaired fasting glucose and impaired glucose tolerance, individuals with prediabetes have elevated blood glucose levels above normal but remain below the threshold for a diagnosis of diabetes. 5 Encouragingly, evidence from the Diabetes Prevention Program, 6,7 Da Qing study 8 and Finnish Diabetes Prevention Study 9 has shown that lifestyle interventions effectively prevented or delayed the onset of diabetes. By modifying diabetes risk factors through increased physical activity and diet modifications, these interventions reduced diabetes risk progression by 58% in three years and prevented the development of microvascular and macrovascular complications for up to 30 years. ...
... By modifying diabetes risk factors through increased physical activity and diet modifications, these interventions reduced diabetes risk progression by 58% in three years and prevented the development of microvascular and macrovascular complications for up to 30 years. 6,10 Despite their proven benefits, implementing these strategies in the context of LMICs remains challenging due to the substantial resources and labour demands. ...
Aims
This study assessed the cost‐effectiveness of a digital health‐supported and community pharmacy‐based lifestyle intervention (PRIME) programme for individuals with prediabetes in Malaysia over a 6‐month period.
Materials and Methods
A trial‐based cost‐effectiveness study with a 6‐month time horizon was conducted. Ninety‐one participants (intervention, n = 46; usual care, n = 45) across 13 community pharmacies were included. The intervention group received in‐depth counselling from pharmacists, in‐app prediabetes education modules and peer support, while the usual care group received counselling based on pharmacists' usual practice. The primary outcome was quality‐adjusted life years (QALY). Incremental cost‐effectiveness ratios (ICER) per QALY gained of the intervention were compared with usual care from healthcare and societal perspectives. Non‐parametric bootstrapping was used to examine uncertainty.
Results
At 6months, the QALY achieved was 0.467 (95% CI 0.456 to 0.479) in the intervention group and 0.466 (95% CI 0.451 to 0.482) in the usual care group, resulting in a net gain of 0.005 QALY (95% CI −0.017 to 0.026) in the intervention group. The incremental healthcare and societal costs were US5.33 to 10.69 (95% CI 15.35), respectively. From a healthcare perspective, the ICER per QALY gained was 2371 and 67.7% from a societal perspective. Results were below the willingness‐to‐pay threshold at $11 845 and were robust to sensitivity analyses.
Conclusion
A community pharmacy‐based and digital health‐supported lifestyle intervention to manage prediabetes may be cost‐effective compared with usual care in Malaysia over a 6‐month period.
... A community-based initiative that helps participants make lifestyle changes to prevent or delay diabetes onset. [20] Washington State Community-Based Prevention Programs Works with community partners to develop policies and support changes to prevent chronic diseases and injuries. [21] Wisconsin Chronic Disease Prevention Program Addresses environments, systems, and health behaviors linked to key chronic diseases through community engagement. ...
... Modification Support Supporting individuals in adopting healthier behaviors through resources such as nutrition counselling and exercise programs. [20,28] ...
Community Health Workers (CHWs) have evolved into strategically important adjunct members of the healthcare portfolio, providing key assistance in the care and management of chronic diseases in marginalized populations. This paper reviews the roles of CHW programs in improving health access, outcomes with dimensions of social utilization such as social determinants, and efficacy of CHW programs in providing health care. Our key findings revealed that CHWs offer culturally competent care, provide ongoing support, and help integrate themselves into the healthcare teams, all in support of chronic disease management. However, there are gaps in the research on different populations, there are limitations in program evaluations due to methodological restrictions, and finding sustainable funding models is still a challenge. This paper therefore urges a coordinated effort between policymakers, healthcare providers, and community organizations to maximize the potential of CHW programs. Interdisciplinary collaboration among healthcare professionals is recommended, as are recommendations for comprehensive training for CHWs and supportive funding frameworks, along with further research to assess the long-term impact of CHW interventions., by adopting these forms of leadership, stakeholders will be able to nurture community health initiatives, create better outcomes for all populations, and enhance overall equity in the healthcare system.
... 7 Studies have shown that up to 58% of type 2 diabetes cases were preventable with diet and exercise health behaviour change interventions. 8 A modest but significant benefit in the prevention of type 2 diabetes has also been demonstrated in women with a history of GDM, with a 26% reduction in T2DM and no significant differences between high-income and middle-income countries. [9][10][11] Despite the solid evidence on prevention in certain countries, the reach of these prevention programs is dismal in real-world settings. ...
... Although 'Evidence-based' is conventionally regarded as the cornerstone of all interventions by the scientific community, it was ranked after 'Universal Access' and 'Equity-Driven' as a guiding principle and value for diabetes prevention. Some participants felt that there was already a sufficient evidence base for diabetes prevention from previous trials, 8,[29][30][31] and noted that the gaps in evidence were around effective implementation. However, there is an absence of diabetes prevention studies in lowincome countries and limited studies in middle-income countries. ...
Aims
The implementation of type 2 diabetes prevention after gestational diabetes (GDM) is poor despite research evidence on efficacy. This is limited by the lack of knowledge of the priorities in real‐world settings from the perspectives of local clinicians and women with lived experiences, particularly those from underserved populations. We report here a global consensus on the values, principles, and research priorities for the implementation of type 2 diabetes prevention in individuals after gestational diabetes (GDM), from the perspectives of clinicians and women from Asia, Africa, Oceania, the Americas, and Europe.
Methods
A team of health professionals and researchers from five continents formed the Cardiometabolic Health Implementation Research in Postpartum individuals (CHIRP) team. The CHIRP team undertook a priority setting process using the Modified Delphi and Nominal Group Technique. Health professionals and women with a lived experience of GDM from five continents were invited to participate. Values, principles, and research priorities were voted on by all participants.
Results
A total of 100 consumers and health professionals from 11 countries across the five continents participated in the consensus process. The top‐ranked values and principles were ‘universal access’, ‘evidence‐based’, and ‘equity‐driven’. The top‐ranked research priorities were ‘stress and mental well‐being’, ‘information on exercise and diet’, ‘lactation and breastfeeding’, ‘exercise after childbirth’, and ‘physical environment for healthy eating’.
Conclusions
Addressing mental wellbeing through strategies that are universally accessible, evidence‐based, and equity‐driven will increase the success of the real‐world implementation and knowledge translation of type 2 diabetes prevention in women with a history of GDM in global settings.
... The recommended approach to managing type 2 DM is to adhere to a regular meal schedule and maintain a diet of high nutritional quality (20,21). In the study, it was found that 42.8% of the participants with type 2 DM were 'skipping meals'. ...
... Haliç Üniversitesi Sağ Bil Derg 2025;8(1):[15][16][17][18][19][20][21][22][23][24][25][26][27][28] ...
Bu çalışmanın amacı, tip 2 diabetes mellituslu (DM) bireylerin beslenme alışkanlıklarını ve hastalıklarıyla ilişkili sorun alanlarını ayrıntılı olarak inceleyerek diyabet yönetimini iyileştirmeye yönelik etkili stratejilerin geliştirilmesine katkıda bulunmaktır. Bu kesitsel çalışma Isparta, Burdur ve Antalya illerinde yürütülmüştür. Araştırmacı, rastgele örnekleme yöntemini kullanarak gönüllü tip 2 DM’li yetişkin bireylere ulaşmıştır. Bu çalışmanın örneklemini belirlemek için yapılan güç analizi sonuçlarına göre en az 984 erkek ve kadın tip 2 DM’li yetişkin bireye ulaşılması hedeflenmiştir. Tip 2 DM’li yetişkin bireylerin demografik parametreleri bir anket formu ile kaydedilmiştir. Katılımcılardan yüz yüze görüşme tekniği kullanılarak antropometrik ölçümler alınmıştır. Araştırmaya katılan bireylere diyabetin sorun alanları ölçeği (DISA) uygulanmış ve “24 saatlik diyet hatırlama” yöntemi kullanılarak besin tüketim kaydı alınmıştır. Enerji (kcal/gün), Protein (g/gün), Karbonhidrat (g/gün), Yağ (g/gün), Lif (g/gün), A vitamini (mcg/gün), C vitamini (mg/gün), E vitamini (mg/gün), B1 vitamini (mg/gün), B12 vitamini (mcg/gün), Sodyum (mg/gün), Kalsiyum (mg/gün), Demir (mg/gün), Bakır (mg/gün), Fosfor (mg/gün) ortalamalarına göre istatistiksel olarak anlamlı bir fark olduğu görülmüştür (p
... A decreasing beta-cell function seems to play a major role in Asian Indians with impaired glucose regulation, specifically with IFG and IGT [12]. The progression rate of IGT to T2D is higher in Asian Indians, with a cumulative incidence of 55.0% in 3 years (18.3% per year) compared with Chinese (11.3% per year), Finnish (6.0% per year) and, American individuals (11 per 100 person-years) [20][21][22]. Furthermore, the risk thresholds of anthropometric measures are lower in Asian people compared with Caucasian Whites, as the risk of T2D increases already at a body mass index (BMI) of >23 kg/m 2 and a waist circumference of 85 cm for men and 75-80 cm for women [23]. ...
... Therapeutic considerations: current approaches Prevention of T2D Several major randomized controlled lifestyle intervention (LI) trials examining the prevention of T2D have been conducted, including the Diabetes Prevention Program (DPP), the Finnish Diabetes Prevention Study (DPS), the DaQing Diabetes Prevention Study (DQDPS), and the Indian Diabetes Prevention Program (IDPP) [20][21][22]110]. The DPP examined >3000 individuals with IFG and IGT without T2D. ...
... However, some Asian cohort studies showed different trends, suggesting that racial differences may influence drug response. Further analyses suggest that Asian populations have a relatively low functional reserve of β-cells, resulting in a greater 32 susceptibility to glucose regulation dysregulation at the same level of insulin resistance, which may partially offset the hepatoprotective effects of metformin. ...
OBJECTIVE To investigate the differences in the efficacy of metformin interventions for progression to type 2 diabetes in people with different subtypes of prediabetes (impaired fasting glucose, impaired glucose tolerance, mixed). MATERIALS AND METHODS Following the PRISMA guidelines, ten Chinese and English databases including PubMed and Cochrane were systematically searched (up to May 2025), and 18 randomized controlled trials were included in a meta-analysis using randomized/fixed-effects models to assess the effect of metformin versus lifestyle/placebo interventions on the incidence of type 2 diabetes, and to calculate the risk ratios (RR) and their 95% confidence intervals (CI), and subgroup analyses were performed based on prediabetes subtype and length of intervention. All statistical analyses were performed using Review Manager 5.4 software. RESULTS Eighteen RCTs were included and found a 35% lower risk of T2DM onset in the metformin group compared with the control group, compared with lifestyle change/placebo (RR = 0.65, 95% CI [0.55, 0.77], P < 0.00001), but there was moderate heterogeneity. Subgroup analysis of participants with different subtypes of prediabetes showed a 62% risk reduction (RR = 0.38, 95% CI [0.38, 0.61], P < 0.0001) for the IFG subtype with the best effect, and a 42% risk reduction (RR = 0.58, 95% CI [0.43, 0.79], P < 0.0004) for the IGT subtype; Mixed risk reduction was 23% (RR = 0.77, 95% CI [0.70, 0.86], P < 0.00001). In addition, intervention duration ≤ 24 months had a more significant effect on the IGT subtype (RR = 0.22, P < 0.0001); a higher proportion of the glycemic inverse metformin group returned to normoglycemia than the control group (RR = 1.80, 95% CI [1.39, 2.34], P < 0.0001). CONCLUSION Metformin can effectively delay the progression of prediabetes to type 2 diabetes, and the intervention effect on IFG subtypes was significantly better than that of IGT and mixed types, which may be related to the mechanism of drug targeting hepatic gluconeogenesis. It is recommended that combined metformin treatment be prioritized for the IFG population.
... Estos cambios deben ser permanentes para que permitan adquirir un nuevo estilo de vida saludable. Las recomendaciones son para la población en general con el objetivo de prevenir el desarrollo de enfermedades crónicas, además están plenamente demostradas como efectivas, incluso se han reportado investigaciones en las que se comprueba que cambios en el estilo de vida referidos a una mejor alimentación y mayor actividad física son más efectivas que el tratamiento con fármacos para evitar la progresión de esta enfermedad (Knowler et al., 2002). ...
La prediabetes es una condición clínica previa a que se declare la diabetes mellitus tipo 2 (DM2) en la que existe una elevación de la glucosa que va progresando a niveles muy altos característicos de la DM2. Así, la prediabetes es una categoría intermedia en la que ya se comienzan a presentar niveles prominentes de glucosa y quienes la padecen es muy probable que desarrollen DM2. La Encuesta Nacional de Salud y Nutrición de 2022 reportó una prevalencia de 22.1% de personas con este padecimiento, que en proporción son dos de cada 10 adultos con edades de 20 años o más, los cuales tienen un mayor riesgo de desarrollar DM2.
... Although dietary patterns show good concordance between the two levels of evidence, there are many examples of discordance [140][141][142][143]. There is a paucity of large RCTs on the effect of nutrition interventions on clinical outcomes with the exception of RCTs of intensive lifestyle interventions for the prevention of T2D [144][145][146][147][148][149][150][151][152], cardiovascular disease in T2D [153], and the Mediterranean diet for primary and secondary cardiovascular disease prevention [51,56,154]. This situation has resulted in multiple calls to reform nutrition research [155]. ...
Guidelines for nutrition therapy of cardiometabolic-based chronic disease (CMBCD) have moved away from nutrient-based recommendations to food/dietary pattern-based recommendations. Dietary patterns that combine the advantages of different foods can result in meaningful improvements in glycemic control, blood lipids, blood pressure, and inflammation. By allowing for flexibility in the proportion of macronutrients in the diet, these dietary patterns provide an opportunity to individualize therapy based on values, preferences, and treatment goals. To assist in the implementation of these dietary patterns into clinical practice, patient and physician engagement tools have been developed including food pyramids, infographics, and apps. Several research gaps remain related to the reliance on small RCTs of intermediate outcomes and observational prospective cohort studies, the lack of large RCTs of clinical outcomes, pragmatic trial designs leveraging primary care networks, and administrative and multi-omics approaches.
... While less effective than lifestyle changes, metformin has been shown to significantly reduce the risk of developing diabetes in prediabetic patients [24]. Nevertheless, only a single randomized controlled study has been conducted on the effects of metformin in psoriasis patients with metabolic syndrome. ...
Introduction: Psoriasis is a chronic inflammatory disorder associated with multiple systemic comorbidities, most notably metabolic syndrome, which affects approximately one-third of individuals with the disease. Metabolic syndrome—characterized by obesity, insulin resistance, dyslipidemia, and hypertension—exacerbates systemic inflammation, further complicating disease management and treatment outcomes. Aim of Study: This review explores the multidisciplinary approach to managing metabolic syndrome in psoriasis, with a particular focus on pharmacological and surgical interventions. It examines the challenges associated with these treatments and their implications for therapeutic efficacy. Brief Description of the State of Knowledge: Psoriasis and metabolic syndrome share a complex, reciprocal relationship driven by chronic inflammation and metabolic dysregulation. While lifestyle modifications remain the cornerstone of management, many patients require additional pharmacological or surgical interventions. However, the presence of metabolic syndrome can alter the safety and effectiveness of systemic and biologic psoriasis therapies, underscoring the need for a personalized treatment approach. Conclusions: Effective management requires interdisciplinary collaboration. Pharmacological treatments should minimize metabolic risks, while bariatric surgery may benefit selected patient groups. Further studies are needed to optimize treatment strategies and improve outcomes.
... The Diabetes Prevention Program (DPP) was a United States multicenter randomized clinical trial [36]. It compared the efficacy and safety of three interventions -an intensive lifestyle intervention, standard lifestyle recommendations combined with metformin, or placebo [25]. ...
Prevention of diabetes requires using of the achievements of basic science in clinical practice. For the last many years it was established that lifestyle factors in preventing type 2 diabetes in people at risk. Subsequent studies have provided important information on the actual implementation of diabetes prevention programs. In some countries efforts for diabetes prevention were realized but it is difficult to extrapolate on work ac-cording a large regional or national programs, specific items which must be scheduled for execution. For trained professionals in the field of health care, medical profile economists, health professionals and representatives of public organizations, capable of interacting with influential politicians. Political support is a very important component of this work. The article presents the results of a study that could help in the successful implementation of diabetes prevention programs in the «Practice of the real world.
... Fortunately, T2DM and associated cardiovascular risks can be prevented by lifestyle involving nutrition and physical activity approaches [3]. Large cohort studies have demonstrated superior effectiveness of lifestyle interventions on T2DM outcomes compared with standard glucose-lowering medications [4][5][6]. Therefore, developing novel nutritional therapeutics for improving glycaemia and lipidaemia T2DM patients is essential alongside standard treatments. ...
Background:
Antioxidants and prebiotics are popular functional foods known for their distinct physiological ameliorating benefits on type 2 diabetes mellitus (T2DM). Whether and how a combined antioxidant-prebiotic supplement affects primary and secondary T2DM outcomes is not known.
Objectives:
We investigated the therapeutic effects of an antioxidant (anthocyanin from riceberry rice) combined with prebiotics (dietary fibre from rice bran and Jerusalem artichoke) on glucose control, lipid profile, oxidative stress, inflammation, and cardiorespiratory fitness in T2DM patients.
Methods:
A total of 60 T2DM patients were randomly assigned to receive antioxidant/prebiotic (supplement group, SG) or maltodextrin (control group, CG), (two capsules (350 mg)/meal after three meals and before bedtime, 2.8 g/day), for 60 days. Venous blood samples were collected at baseline and after 60 days intervention to assess blood metabolic variables (glucose, insulin, and lipid profiles, renal and liver functions, oxidative stress, inflammation). Nutrition status, anthropometry, body composition (DEXA) and cardiorespiratory fitness were also measured.
Results:
Analysis of co-variance showed superior effects on T2DM's glucose and lipid profiles in the SG compared with the CG including reduced fasting blood glucose (p = 0.01 within-group effects, p = 0.03 interaction effects), reduced glycated haemoglobin (p = 0.004 within-group effects, p = 0.002 interaction), and reduced low density lipoprotein (p = 0.006 within-group effects, p = 0.02 interaction effects). No significant change was found within the CG for any of these parameters. Kidney function's glomerular filtration rate was also improved in the SG (p = 0.01 within-group effects), but not in the placebo CG. Intermediatory biomarkers of oxidative stress, inflammation, and cardiorespiratory fitness were not significantly affected in either group with no interaction effects. No adverse effects were detected following the 60-day supplementation intervention.
Conclusions:
The findings suggest that a combined anthocyanin-fibre may be promoted as an adjacent therapy in patients with T2DM, but the intermediary mechanisms of action require further research.
... We excluded trials using vitamin D-fortified food (eg, yogurt), or a combination of vitamin D and calcium to ensure the ability to isolate the specific effect of vitamin D on the outcome of interest. Trials that lasted less than 6 months were excluded to allow sufficient time for serum 25-hydroxyvitamin D (25[OH]D) levels to plateau and for the natural history of prediabetes to evolve [16][17][18][19]. Potentially relevant articles were screened in full text by P.K. and A.G.P., independently. ...
Meta-analyses of clinical trials have shown that vitamin D lowers the risk of progression from prediabetes to diabetes. Less is known about whether vitamin D promotes regression to normal glucose regulation (NGR). We conducted a systematic review and meta-analysis of clinical trials with vitamin D in adults with prediabetes that have reported on the outcome of regression to NGR.
We searched Medline (through PubMed), Embase, and the trial registry ClinicalTrials.gov from inception to July 3, 2024 for randomized, controlled trials of at least 6 months’ duration that reported on the effects of oral vitamin D supplementation on NGR in adults with prediabetes.
The search identified 10 eligible trials, involving 4478 participants. The baseline characteristics of the study cohorts were: mean age range 20-74 years old, mean BMI range 24-38 kg/m2, mean blood 25-hydroxyvitamin D range 12-28 ng/mL. The median study duration range was 0.5-5 years. Across trials, 416/2253 (18.5%) participants randomized to vitamin D reached NGR versus 312/2225 (14.0%) participants randomized to placebo. In all trials, the relative risk of regression to NGR favored the vitamin D group, ranging from 1.09 to 12.6. After combining data, the summary relative risk of regression to NGR for vitamin D vs placebo was 1.27 (95% CI 1.12-1.45), with no heterogeneity (I2 = 1%). Sensitivity analyses did not change the result. Participant-level variables were not available, limiting meaningful subgroup analyses.
In conclusion, vitamin D increases the likelihood of regression to normoglycemia in adults with prediabetes.
... The Diabetes Prevention Program (DPP) was a large randomized trial demonstrating lifestyle interventions' effectiveness in preventing type 2 diabetes [15]. Modifying lifestyle habits is both an effective and economical approach to prevent and manage chronic conditions in lowresource settings [16]. ...
... The incidence of diabetes was 58% lower in the intense modification group, and 31% lower in the group using metformin, when compared to the placebo group. And finally, the incidence of diabetes was 39% lower in the lifestyle intervention group than in the metformin group [21]. ...
The aim of this study was to evaluate clinical and laboratory results found in the database of an institution for the prevention, promotion and recovery of health. Clinical and laboratory parameters were observed during the examination of 458 medical records of patients who underwent a clinical program of acute lifestyle intervention, and what changes were produced by this treatment. The clinical parameters evaluated were body weight and waist circumference. In the statistical analysis, with statistical significance (p<0.05), there was an improvement in the biochemical indices studied in both groups, especially in the group with longer permanence, improvement in body weight, and there was also a significant improvement (p<0.05) in those with metabolic syndrome, among whom approximately 36% no longer had this condition. Acute lifestyle intervention reduced or reversed risk factors for coronary artery disease and the presence of metabolic syndrome.
... The effectiveness of the interventions could be related to the baseline body mass index (BMI). In the study by Knowler et al., it was documented that prevention of prediabetes with metformin was greatest in those with a higher baseline BMI [20]. In view of these limitations, this meta-analysis was conducted with the aim to assess metformin (exclusively) in pre-diabetes using the random-effects model aiming at identifying heterogeneity if any, and trying to explore the clinical and laboratory attributes contributing to it. ...
OBJECTIVE: The aim of this meta-analysis was to explore the effectiveness of metformin in retarding the progression of pre-diabetes to type 2 diabetes (T2D). MATERIALS AND METHODS: A web-based search was conducted using the Cochrane Library identifying ten citations for analysis. In the pre-analysis stage, outlier detection was carried out using funnel plots, culprit citations identified using Byjat plot and influence analysis. The meta-analysis was conducted using a random-effects model using relative-risk (RR) as the effect-size and prediction interval (PI) as the indicator of heterogeneity. The RR was calculated by comparing the metformin and the control arm [lifestyle modification (LSM)/placebo]. R studio (2022.07.1, Build 554) software was used for analysis. RESULTS: A total of 8869 patients with pre-diabetes were included in the meta-analysis, with 4328 patients in the metformin arm and 4541 in the control arm (LSM/placebo). There was a 22% RR reduction with metformin compared to LSM/placebo with a 95% CI of 0.71–0.86. No heterogeneity was detected in the summary effect size (PI: 0.69–0.88). Subgroup analysis using the dose of metformin (low versus high) did not influence the outcome (p = 0.39) CONCLUSIONS: The addition of metformin to intensive LSM is an effective value addition in patients with pre-diabetes at high-risk of progression to T2D.
... Indeed, caloric restriction and increased exercise have been demonstrated to improve components of the syndrome (waist circumference, blood pressure, and lipid profile) and decrease the progression to frank diabetes mellitus. 25 The other important pathological process activated by the metabolic syndrome is inflammation, which is associated with the development and progression of atherosclerosis. 26 Increasing levels of inflammation, as measured by blood markers such as C-reac-tive protein, predict incident cases of symptomatic atherosclerosis, including MI, stroke, and PAD. ...
In the past decade, impressive strides have been made in the diagnosis and management of atherosclerotic, aneurysmal, and thromboembolic diseases, thanks in large part to the explosive growth in both vascular biology and clinical vascular medicine. We review what we consider to be the top 12 advances in this field: the discovery of nitric oxide, the metabolic syndrome, new thrombophilic disorders, therapeutic angiogenesis, endoluminal treatment of chronic venous disease, and a variety of drugs, including sildenafil, cilostazol, low-molecular-weight heparins, oral direct thrombin inhibitors, clopidogrel, statins, and angiotensin-converting enzyme inhibitors and angiotensin-receptor blocking agents.
... A meta-analysis that identified the association between fasting glycaemia and risk of future diabetes 35 indicates that a reduction of fasting glucose from 6.4 to 6.1 mmol l −1 , as observed in response to BSE, would correspond to a diminished hazard ratio for diabetes onset from ~12 to ~7, and a decrease from 6.4 to 6.0 mmol l −1 , as observed in response to BSE in the cluster with MARD-like characteristics, corresponds to an ~50% reduction in hazard ratio. Although we cannot estimate the precise risk reduction based on these data, it is of relevance that BSE, despite not meeting the prespecified target of 0.3 mmol l −1 , reduces fasting blood glucose by a similar magnitude (0.2 mmol l −1 ) to that observed with metformin (which decreased fasting blood glucose by ~0.2 mmol l −1 in the Diabetes Prevention Program and reduced diabetes incidence by 31% for 3 years) 36 . In view of the low cost of BSE, it is also of note that risk reductions as small as 5% have been shown to be clinically cost-effective owing to the large societal costs of diabetes 37 . ...
More effective treatments are needed for impaired fasting glucose or glucose intolerance, known as prediabetes. Sulforaphane is an isothiocyanate that reduces hepatic gluconeogenesis in individuals with type 2 diabetes and is well tolerated when provided as a broccoli sprout extract (BSE). Here we report a randomized, double-blind, placebo-controlled trial in which drug-naive individuals with prediabetes were treated with BSE (n = 35) or placebo (n = 39) once daily for 12 weeks. The primary outcome was a 0.3 mmol l⁻¹ reduction in fasting blood glucose compared with placebo from baseline to week 12. Gastro-intestinal side effects but no severe adverse events were observed in response to treatment. BSE did not meet the prespecified primary outcome, and the overall effect in individuals with prediabetes was a 0.2 mmol l⁻¹ reduction in fasting blood glucose (95% confidence interval −0.44 to −0.01; P = 0.04). Exploratory analyses to identify subgroups revealed that individuals with mild obesity, low insulin resistance and reduced insulin secretion had a pronounced response (0.4 mmol l⁻¹ reduction) and were consequently referred to as responders. Gut microbiota analysis further revealed an association between baseline gut microbiota and pathophysiology and that responders had a different gut microbiota composition. Genomic analyses confirmed that responders had a higher abundance of a Bacteroides-encoded transcriptional regulator required for the conversion of the inactive precursor to bioactive sulforaphane. The abundance of this gene operon correlated with sulforaphane serum concentration. These findings suggest a combined influence of host pathophysiology and gut microbiota on metabolic treatment response, and exploratory analyses need to be confirmed in future trials. ClinicalTrials.gov registration: NCT03763240.
... The implementation of lifestyle-changing programs to modify the lifestyle, daily activities, and diet of individuals with prediabetes have been demonstrated to substantially reduce the risk of developing T2DM [6]. For instance, the Diabetes Prevention Programme (DPP) demonstrated that lifestyle intervention reduced the incidence of T2DM by 58 % over an average of 2.8 years [7]. This finding was similarly observed in both the Finnish Diabetes Prevention Study and the Chinese Da Qing Diabetes Prevention Study which concluded that lifestyle changes could prevent T2DM [8,9]. ...
... However, patients face many challenges in implementing dietary management, such as a lack of relevant knowledge and difficulties in adaptation, which collectively contribute to low compliance [12]. With the continuous rise in the incidence of diabetes, dietary management has become an important component of health education, attracting widespread attention from both patients and healthcare professionals [13]. Healthcare professionals need to understand the current situation of patients in the dietary management process, identify and address the factors that promote and hinder patients' dietary management. ...
Background
Adherence to dietary guidelines is a fundamental aspect of diabetes management; however, it poses a significant challenge for patients with diabetes. Our research aims to assess the level of dietary compliance among individuals with type 2 diabetes (T2DM) and to identify the factors that influence their adherence to dietary advice.
Methods
This study was a cross-sectional survey. The patients with T2DM undergoing treatment at our hospital from March, 2023, to June, 2024 were included. Compliance with dietary recommendations was assessed using the validated dietary compliance scale for type 2 diabetes mellitus patients (DCS-T2DM). Spearman correlation and logistic regression analyses were conducted to evaluate the factors influencing dietary compliance in patients with T2DM.
Results
A total of 308 T2DM patients were included in our study. The results revealed that 46.10% of the participants had suboptimal dietary compliance. There were significant correlations between dietary compliance and several demographic and clinical factors, including age (r = 0.501), gender (r = 0.447), education level (r = 0.610), average monthly household per capita income (r = 0.627), and the duration, since T2DM diagnosis (r = 0.552), all of which were statistically significant (p < 0.05). Logistic regression identified age (OR = 1.705, 95%CI 1.262 ~ 1.987), gender (OR = 2.401, 95%CI 1.909 ~ 3.134), education level (OR = 3.083, 95%CI 2.434 ~ 3.957), average monthly household per capita income (OR = 3.721, 95%CI 2.553 ~ 4.405), and the time since T2DM diagnosis (OR = 2.470, 95%CI 1.755 ~ 3.262) as significant predictors of dietary compliance.
Conclusions
46.10% of patients with T2DM exhibited suboptimal dietary adherence, with age, gender, education, income, and diabetes duration significantly predicting compliance. It is imperative for healthcare providers to devise individualized intervention strategies that incorporate these pivotal factors to enhance dietary adherence in patients with T2DM.
Diabetes mellitus (DM) is a growing public health concern globally, particularly in Saudi Arabia, where increasing prevalence is associated with significant morbidity. This study aimed to assess the prevalence of diabetes-related complications among patients in Riyadh and examine the impact of sociodemographic factors, comorbidities, and lifestyle habits on these complications. A cross-sectional study was conducted with 980 diabetic patients attending health centers in Riyadh from March to April 2023. Data were collected via a validated bilingual questionnaire that captured sociodemographic information, diabetes-related variables, comorbid conditions, lifestyle habits, and complications. Statistical analyses, including descriptive statistics, chi-square tests, and binary regression, were performed via SPSS to identify significant associations. A p-value less than 0.05 was considered significant for all comparisons. Among the participants (980), 38% (378) reported diabetes-related complications, primarily neuropathy (30%), retinopathy (25%), and cardiovascular diseases (20%). Complications were significantly associated with older age (p < 0.001) and longer diabetes duration (more than 5 years; p < 0.001). Individuals with hypertension, hyperlipidemia, heart disease, kidney disease, and obesity had significantly higher complication rates than those without these conditions (p < 0.05). The most pronounced association was observed in participants with heart disease (85% vs. 15%; RR = 1.506), highlighting the need for better management of these comorbidities. Consuming fruits and vegetables, milk, and regular exercise were inversely associated with the risk of complications (p < 0.05). Conversely, sugary drinks, white bread, sheesha/vaping, and inadequate sleep were linked to increased risk (p < 0.05), highlighting the protective role of healthy dietary and lifestyle habits. This study highlights the impact of sociodemographic factors and lifestyle choices—such as age, education, family history, comorbidities, and poor diet—on diabetes complications. While early detection and lifestyle interventions are vital, a cautious approach is needed when applying these findings to other regions, given differences in socioeconomic circumstances.
Background/Objectives: Despite advances in public health and medical treatment, the number of patients with type 2 diabetes is increasing and it remains among the top 10 causes of death and a leading cause of disability in the United States. Early interventions with innovative approaches are essential to improving dietary intake and blood glucose control, potentially preventing or delaying type 2 diabetes and related complications. This study examined the effects of integrating real-time feedback from continuous glucose monitoring (CGM) into individualized nutrition therapy (INT) on diet and sleep quality in individuals with prediabetes and overweight or obesity. Methods: Thirty participants were randomized to either the treatment (n = 15) or the control group (n = 15). Both groups received individualized nutrition recommendations tailored to energy needs for weight maintenance and blood glucose control. The treatment group had real-time access to CGM data, while the control group remained blinded. Dietary intake and sleep quality were assessed using ASA24 recall and analyzed via general linear model repeated measures. Results: Incorporating CGM feedback into nutrition therapy significantly increased whole-grain (p = 0.02) and plant-based protein intake (p = 0.02) in the treatment group, with trends toward increased fruit intake (p = 0.07) and a reduced percentage of calories from carbohydrates (p = 0.08). Sleep efficiency also improved significantly by 5% (p = 0.02) following the intervention. Conclusions: These findings support the effectiveness of CGM-enhanced nutrition therapy in improving diet and sleep quality in individuals with prediabetes and overweight or obesity. Further research is needed to assess the sustainability and long-term impact of this approach.
The timing of dietary total fat intake influences glucose homeostasis, however, the impact of unsaturated fat (USFA) intake has yet to be explored. This 12-week, double-blind, randomized, controlled, 2 × 2 factorial-designed feeding trial investigated the effects of timing (lunch or dinner) and types of dietary USFA (high monounsaturated fat or polyunsaturated fat diet) intake on glucose metabolism in seventy prediabetes participants (mean age, 57 years). Sixty participants with completed fecal samples were included in the final analysis (n = 15 for each group). Postprandial serum glucose was first primary outcome, postprandial insulin levels and insulin sensitivity indices were co-primary outcomes Secondary outcomes were continuous glucose levels, serum fatty acid profile, gut microbiome (metagenomic sequencing) and fecal metabolites. Results showed no significant differences in postprandial glucose between groups. However, USFA intake at lunch (vs. dinner) improved insulin sensitivity and reduced postprandial insulin and serum free saturated fatty acid (Ptiming < 0.05, Ptype > 0.05, Pinteraction > 0.05), which was associated with alterations in gut microbiome and bile acid metabolism, regardless of USFA type. In summary, these results suggest that advancing timing of USFA intake improves insulin sensitivity through the gut microbiome and bile acid metabolism. Trial registration: ChiCTR2100045645.
Maintaining a healthy diet is an important strategy in public health to prevent chronic disease states. Providing nutritional therapy to hospitalized patients at high nutritional risk helps mitigate the deterioration of nutritional status and improve clinical outcomes. Despite the expectations of patients and members of the general public that physicians should serve as experts in clinical nutrition, their education remains relatively insufficient in this regard throughout their training from medical school through postgraduate studies. This creates a gap between the expertise needed to optimize benefits from nutritional therapy and the lack of training and knowledge base in physicians expected to provide that expertise. This chapter will discuss the importance of nutritional education in lifestyle medicine, address the reasons for gaps between the need for skills in nutritional management and the lack of training to prepare physicians for that responsibility, and provide solutions for closing those knowledge gaps in the future.
Adiposity-based chronic disease (ABCD) is a medically actionable diagnostic term that conceptualizes and entrains complications-centric care since it indicates what is being treated (adiposity-based: abnormalities in the mass, distribution, and function of adipose tissue) and why it is being treated (chronic disease: prevention and treatment of complications that impair health). Additionally, ABCD provides a framework for primordial, primary, secondary, and tertiary disease treatment and prevention. This chapter explains the ABCD conceptual model, its pathophysiology, and modalities for prevention and treatment, with lifestyle therapy being key at each phase of the progression of this chronic disease. This chapter also discusses the implications of ABCD as a diagnostic term regarding complications-centric care and patient evaluation, disease coding systems, and the development of a rational chronic disease care model.
Lifestyle medicine is the nonpharmacological/nonprocedural management of chronic disease and has evolved in response to significant clinical and economic burdens. However, optimizing implementation tactics that leverage evidence-based lifestyle medicine strategies has been challenging. In Europe, several lifestyle medicine centers (LMCs) with structured clinical activities and quantifiable results have been developed to address this challenge. The first optimization step is accreditation—a force multiplier—which incentivizes and optimizes a LMC based on adherence to evidence-based best practice standards. Ultimately, the strategic goal of accreditation is to create a viable European network of multiple LMCs facilitating superior performance metrics (e.g., response, sustainability, and safety), research, scientific information exchange, and multicenter clinical trials. Accreditation will be granted at three levels: certified, certified with distinction, and certified with premier distinction, with annotations corresponding to approved specializations (e.g., diabetes, obesity, cancer, and cardiovascular diseases). Logistically, the accreditation process will be managed by a committee under the auspices of the European Lifestyle Medicine Organization. Performance metrics from facilities, policies and protocols, competencies, leadership and human resources, and other immersive patient-oriented attributes will be requested and evaluated from candidate LMCs. In conclusion, a standardized process for European LMC accreditation will foment a culture of high-quality lifestyle medicine by closing established research, knowledge, and practice gaps.
Noncommunicable metabolic disease has markedly increased in prevalence worldwide over recent decades. Driven by insulin resistance, with coincident associated risks and potential complications, the progression of an individual patient with dysglycemia-based chronic disease (DBCD) may be classified in a 4-stage system. The recognition of early stages, including patients with insulin resistance or patients with mild hyperglycemia, also known as prediabetes, allows for early intervention. Such identification should trigger a review and substantive modification in routine lifestyle choices that significantly reduce the risks of progression and complication. In patients already at more advanced stages of DBCD, such as those with type 2 diabetes or atherosclerotic disease, lifestyle interventions still provide clinical benefits and reduction in risk of further adverse developments.
The evaluation of patients with DBCD includes scrutiny of nearly every aspect of lifestyle. Commonly actionable factors include dietary patterns, physical activity, tobacco use, alcohol consumption, marijuana use, stress reduction, sleep and circadian rhythm, exposure to endocrine-disrupting chemicals, and social determinants of health. In each of these categories, clinical evidence is suggestive for optimization. However, a further study of all aspects can lead to novel approaches, support consensus views, guidelines, and policy development, and lead to a more complete understanding of the evaluation and treatment of patients with DBCD.
Diabetes, one of the representative chronic diseases and a key risk factor for cardiovascular disease, is continuously increasing in prevalence. The complications associated with metabolic diseases, such as hypertension and dyslipidemia are becoming significant public health concern. In general, diabetes is a progressive disease that requires active treatment upon onset, and the number of medications needed tends to increase over time. Due to these characteristics, treatment and management in the prediabetic stage are being emphasized. In addition to the increasing prevalence of diabetes, the prevalence of prediabetes in Korea is also gradually increasing to 41.1% in adults aged 30 years or older and 47.7% in adults aged 65 years or older. This trend is driven by various factors such as westernized lifestyle, rising obesity rates, and environmental factors such as age, diet, lack of exercise, stress, and medications. In this article, I introduce key points for prevention of progression to diabetes in the prediabetic stage.
Obesity is a highly prevalent chronic multisystem disease associated with shortened life expectancy due to a number of adverse health outcomes. Epidemiological data link body weight and parameters of central fat distribution to an increasing risk for type 2 diabetes, hypertension, fatty liver diseases, cardiovascular diseases including myocardial infarction, heart failure, atrial fibrillation, stroke, obstructive sleep apnoea, osteoarthritis, mental disorders and some types of cancer. However, the individual risk to develop cardiometabolic and other obesity‐related diseases cannot entirely be explained by increased fat mass. Rather than excess fat accumulation, dysfunction of adipose tissue may represent the mechanistic link between obesity and adverse health outcomes. There are people living with obesity who seem to be protected against the premature development of cardiometabolic diseases. On the other hand, people with normal weight may develop typical obesity diseases upon dysfunction of adipose tissue and predominantly visceral fat distribution. The mechanisms linking impaired function of adipose tissue in people with obesity include adipocyte hypertrophy, altered cellular composition, limited expandability of safe subcutaneous fat stores, ectopic fat deposition in visceral depots, the liver and other organs, hypoxia, a variety of stresses, inflammatory processes, and the release of pro‐inflammatory, diabetogenic and atherogenic signals. Genetic and environmental factors might contribute either alone or via interaction with intrinsic biological factors to variation in adipose tissue function. There are still many open questions regarding the mechanisms of how increased body weight causes obesity‐related disorders and whether these pathologies could be reversed. Evidence‐based weight loss interventions using behaviour change, pharmacological or surgical approaches have clarified the beneficial effects of realistic and sustained weight loss on obesity‐related complications as hard outcomes. This review focusses on recent advances in understanding epidemiological trends and mechanisms of obesity‐related diseases.
Plain Language Summary
Obesity is a chronic complex and progressive disease characterized by excessive fat deposition that may impair health and quality of life. Worldwide, the number of adults living with obesity has more than doubled since 1990. Obesity may lead to reduced life expectancy, because it increases the risk for type 2 diabetes, cardiovascular diseases (e.g., myocardial infarction, high blood pressure, stroke), fatty liver diseases, musculoskeletal diseases, chronic respiratory diseases, depression and certain types of cancer. However, not every person with obesity develops these diseases. For better prevention and treatment, it is important to understand the mechanisms linking high fat mass to obesity related diseases. It has become clear that fat mass alone cannot explain the higher risk of obesity complications. People with obesity can have either high or low risk of developing complications. Compared to people with a low risk for obesity complications those with a high risk to develop obesity related diseases are characterized by higher central fat deposition in the abdominal region, on average bigger fat cells, higher number of immune cells in adipose tissue and altered signals released from adipose tissue that may directly affect the brain, liver, vasculature and other organs. Both inherited and environment factors may cause these abnormalities of adipose tissue function. However, weight loss through behaviour changes (e.g., lower calorie intake, higher physical activity), medications or obesity surgery can improve health, quality of life and reduce the risk for obesity related diseases.
Background
Patients with type 2 diabetes (T2D) often experience prolonged periods of asymptomatic hyperglycemia, which significantly increases the risk of developing chronic complications related to diabetes. Screening programs for individuals at high risk for T2D provide valuable opportunities not only for early diagnosis but also for detecting intermediate hyperglycemic states, commonly referred to as prediabetes. Interventions aimed at preventing diabetes in this group can successfully delay or even avoid the onset of the disease and its associated burdens. This review is an update of the Brazilian Diabetes Society (Sociedade Brasileira de Diabetes [SBD]) evidence-based guideline for diagnosing diabetes and screening T2D.
Methods
The methodology was previously published and defined by the internal institutional steering committee. The working group drafted the manuscript by selecting vital clinical questions for a narrative review, utilizing MEDLINE via PubMed to identify relevant studies. The review assessed the best available evidence, including randomized clinical trials (RCTs), meta-analyses, and high-quality observational studies related to the diagnosis of diabetes.
Results and conclusions
Fifteen specific recommendations were formulated. Screening is recommended for adults aged 35 and older or younger individuals with obesity and additional risk factors. For children and adolescents, screening is recommended starting at age ten or the onset of puberty if they are overweight or obese and have additional risk factors. Fasting plasma glucose (FPG) and HbA1c are recommended as initial screening tests. The oral glucose tolerance test (OGTT) is recommended for high-risk individuals with normal HbA1c and FPG or those with prediabetes. The 1-h OGTT is preferred over the 2-h OGTT, as it is both more practical and a superior test. A structured approach to reevaluation intervals is provided.
The positive relationship between higher delay discounting, an indicator of increased impulsivity, and reduced engagement in diabetes care has been investigated. However, the association between delay discounting and diabetes onset, likely linked through unhealthy behaviors, has not been well investigated. Additionally, although depression has been linked to an increased risk of diabetes and greater delay discounting, studies examining associations among all three factors are scarce. The present study aimed to determine the association between depressive symptoms and the onset of diabetes, with delay discounting as a mediator of this relationship.
Using data from a three-phase online prospective survey of a community sample, cross-sectional and longitudinal mediation analyses were conducted to examine diabetes prevalence from Phase 1 and incidence from Phases 2 and 3 as the outcomes, with depressive symptoms at Phase 1 as the independent variable and delay discounting at Phase 1 as the mediator.
Delay discounting was positively associated both with diabetes prevalence (coefficient = 0.170; 95% confidence interval [CI] = 0.066 to 0.278; P = 0.002) and incidence (coefficient = 0.306; 95% CI = 0.098 to 0.540; P = 0.006). Furthermore, through delay discounting, depressive symptoms were indirectly associated with diabetes prevalence (indirect coefficient = 0.091; 95% bootstrap CI = 0.034 to 0.149) and incidence (indirect coefficient = 0.138; 95% bootstrap CI = 0.037 to 0.256), respectively.
Delay discounting may increase the risk of diabetes onset by mediating the positive association between depressive symptoms and diabetes onset.
Metformin has been shown to possess immune-modulating and anti-inflammatory effects in various animal and clinical studies. It is believed to be effective in treating some immune-mediated inflammatory diseases (IMIDs). However, there remains ongoing debate regarding the extent to which metformin can reduce the risk of developing IMIDs. We used the data from genome-wide association studies to explore the causal relationship between metformin treatment and some IMIDs through the Mendelian randomization (MR) analysis. Additionally, sensitivity analyses were performed using the Cochran Q -test, MR-PRESSO and “leave-one-out” to confirm the robustness of our conclusions. The MR analysis indicated that metformin treatment could reduce the risk of rheumatoid arthritis (RA) (OR = 0.018, 95% CI: 1.33 × 10 ⁻³ –0.233, P = .002), multiple sclerosis (MS) (OR = 0.966, 95% CI: 0.936–0.997, P = .030) and primary sclerosing cholangitis (PSC) (OR = 6.82 × 10 ⁻⁴ , 95% CI: 7.83 × 10 ⁻⁶ –5.93 × 10 ⁻² , P = .001). But metformin treatment is not significantly associated with the risk of Crohn disease (OR = 0.994, 95% CI: 0.979–1.009, P = .431), ulcerative colitis (UC) (OR = 0.987, 95% CI: 0.965–1.009, P = .234), systemic lupus erythematosus (SLE) (OR = 164.373, 95% CI: 0.158–1.71 × 10 ⁵ , P = .150), autoimmune hepatitis (AIH) (OR = 2.909, 95% CI: 4.58 × 10 ⁻³ –1.85 × 10 ³ , P = .746) and primary biliary cholangitis (PBC) (OR = 0.055, 95% CI: 1.44 × 10 ⁻³ –2.112, P = .119). Due to the heterogeneity of the data from UC, SLE, MS, and PBC, we adjusted them. After adjustment, there is no change in the results for UC, SLE, MS, and PBC. The findings of this study support metformin treatment may reduce the risk of RA, MS, and PSC.
Aims
Oral treatment extended‐release naltrexone/bupropion (NB) leads to significant weight loss, but its effect on body composition remains unclear. We investigated changes in body composition with dual‐energy x‐ray absorptiometry after treatment with NB or placebo in a subgroup of participants from a randomized control phase 3 study (COR‐I).
Materials and Methods
Observed changes from baseline to week 52 were estimated for total, lean, and fat mass. Changes in body composition were evaluated using linear regression and adjusted for baseline covariates.
Results
The analysis included 82 participants (placebo, n = 26; NB, n = 56) with comparable baseline characteristics (age, BMI, sex). The NB group experienced a significant −7.8% change of total mass (−12.9% change in fat mass and −4.1% in lean mass), compared with a −2.8% change of total mass (−4.8% change in fat mass and −1.4% in lean mass) in the placebo group. The adjusted changes in lean‐to‐fat mass ratio of 0.069 in the NB group and −0.056 in the placebo group were significantly different ( p < 0.05).
Conclusions
NB‐induced weight loss is associated with significant reductions in total percent fat mass, increase in total percent lean mass, and change in lean‐to‐fat mass ratio, in comparison to placebo. Larger studies are needed to further elucidate the clinical significance of these changes and impact of a potentially healthier metabolism.
Background
Behavioral weight loss (WL) interventions typically follow standard diet and activity prescriptions for intervention duration to produce an energy deficit. Though average weight losses in these programs are clinically meaningful, there is heterogeneity in weight outcomes. Personalized diet and activity prescriptions may help increase the potency of WL programs by reducing this heterogeneity.
Methods
This 12‐week pilot study randomized participants (n = 35; BMI 34.6 ± 4.9 kg/m², 34% with HbA1c 5.7%–6.4%) in a 3:1 ratio to a Personalized Behavioral Weight Loss (PBWL) or standard BWL and compared the feasibility and efficacy of these approaches. Both groups received a study mobile app, smart scale, activity tracker, and weekly telephone coaching sessions; PBWL participants received a continuous glucose monitoring device. PBWL participants had goals for 1) macronutrient composition (low fat or carbohydrate), 2) meal frequency (3 meals or meals and snacks), and 3) activity focus (daily or weekly goal); they experimented with different 3‐part prescriptions, in random order and combination, for the first 4 weeks then picked their 3 goals to follow for weeks 5–12.
Results
Study retention (100%) and satisfaction were high. Mean 3‐month weight loss (kg) was greater in PBWL (−7.08 (0.74)) than BWL (−3.79 (0.84), P = 0.03); 74% of PBWL and 63% of BWL participants were “optimizers” who achieved a 5% weight loss at 3 months. PBWL optimizers lost more weight (−8.66 (0.66)) than BWL optimizers (−4.76 (0.43), p < 0.001).
Conclusions
Experimentally‐derived personalized prescriptions supported greater 12‐week weight loss than standard recommendations.
Trial Registration: ClinicalTrials.gov NCT04639076.
Objective
The objective of this study was to investigate the efficacy and safety of the Epitomee capsule versus placebo as an adjunct to high‐intensity lifestyle intervention in participants with overweight or obesity.
Methods
The Randomized Evaluation of Efficacy and Safety of the Epitomee Capsule Trial (RESET) was a prospective, double‐blind, placebo‐controlled pivotal trial in adults with baseline BMI of 27.0 to 40.0 kg/m ² . The co‐primary endpoints at week 24 were percentage change from baseline in body weight for the Epitomee and placebo groups and proportion of Epitomee‐treated patients achieving ≥5% weight loss compared with a 35% threshold. The primary safety endpoint was the incidence of device‐related serious adverse events.
Results
A total of 138 participants received Epitomee and 141 received placebo. Mean (SD) change in body weight from baseline was −6.6% (6.5%) with Epitomee and −4.6% ( 4.7%) with placebo; least‐squares means were −6.1% (0.6%) and −4.2% (0.6%), respectively ( p = 0.0054). Fifty‐six percent of Epitomee‐treated participants attained ≥5% weight loss from baseline, which was significantly greater than the 35% predefined threshold ( p < 0.0001). Twenty‐seven percent of Epitomee‐treated and eleven percent of placebo‐treated participants achieved ≥10% weight loss. Adverse event rates were similar between the groups. No device‐related serious adverse events occurred.
Conclusions
The Epitomee capsule is a safe and efficacious nonpharmacological option for weight management with potential broad application in participants with overweight or obesity.
Diabetes mellitus is a chronic metabolic disorder with far-reaching implications for individuals and healthcare systems worldwide. Lifestyle interventions, encompassing dietary modifications, physical activity, and behavioral changes, have emerged as critical strategies in mitigating diabetic complications. This paper explores the role of lifestyle interventions in preventing and managing complications associated with diabetes, emphasizing their efficacy, challenges, and the need for integrated approaches. By addressing these factors, healthcare professionals can enhance patient outcomes and reduce the burden of diabetes-related complications.
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