Prevention
ÎT2DM 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).
ÎPersons 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).
ÎIn 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 (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
> Consideration may be given to laparoscopic-assisted gastric banding in patients with T2DM who have a body mass index > 30 kg/m2 for patients with a body mass index > 35 kg/m2
(D-4).
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).
to achieve at least short-term or Roux-en-Y gastric bypass
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