Prevention
ÎÎT2DM can be prevented or at least delayed by intervening in persons
who have prediabetes (see Table 1 for prediabetes risk factors
suggesting a need for screening). Monitoring of patients with
prediabetes to assess their glycemic status should include at least
annual measurement of fasting plasma glucose (FPG) and/or an oral
glucose tolerance test (OGTT) (Table 2) (D-4).
>> Hemoglobin A1c (HbA1c) should be for screening use only (D-4).
>> Cardiovascular disease (CVD) risk factors (especially elevated blood pressure
and/or dyslipidemia) and excessive weight should be addressed and monitored at
regular intervals (D-4).
ÎÎPersons with prediabetes should modify their lifestyle, including initial
attempts to lose 5% to 10% of body weight if overweight or obese and
participation in moderate physical activity (eg, walking) at least 150
minutes per week (D-4).
>> Organized programs with follow-up appear to benefit these efforts (A-1).
ÎÎIn addition to lifestyle measures, metformin or perhaps a
thiazolidinedione (TZD) should be considered for:
>> younger patients who are at moderate to high risk for developing DM
>> for patients with additional CVD risk factors including hypertension,
dyslipidemia, or polycystic ovarian syndrome
>> for patients with a family history of DM in a first-degree relative
>> and/or for patients who are obese (A-1).
ÎObesity is a major risk factor for T2DM and for CVD. Lifestyle modification
Î
(primarily calorie reduction and appropriately prescribed physical activity)
is the cornerstone in the control of obesity in T2DM (A-1).
>> Pharmacotherapy for weight loss may be considered when lifestyle modification
fails to achieve the targeted goal in patients with T2DM and a body mass index
> 27 kg/m2 (D-4).
>> Consideration may be given to laparoscopic-assisted gastric banding in patients
with T2DM who have a body mass index > 30 kg/m2 or Roux-en-Y gastric bypass
for patients with a body mass index > 35 kg/m2 to achieve at least short-term
weight reduction (A-1).
▶▶ Patients with T2DM who undergo Roux-en-Y gastric bypass must have
meticulous metabolic postoperative follow-up because of a risk of vitamin and
mineral deficiencies and hypoglycemia (D-4).
1
