Prevention of Diabees-Is it possible??

·         Prevention of T2D Is it a still a myth ?? : In Indian study it was revealed that behavior modification can slow the progression to T2D but can’t prevent the DM .Not only Lifestyle but metformin independently reduced progression of IGT to T2DM but can’t prevent its onset. The diabetes prevention trials, in general, involved intensive individualized interventions. Translational research has shown that less expensive, group based lifestyle interventions are also effective in achieving weight loss, thereby reducing risk of T2D.
Prevention of T2D is undoubtedly cost effective. Several large clinical trials have demonstrated that T2D can be delayed or prevented by lifestyle intervention or medications. Most of these studies involved subjects with impaired glucose tolerance (1GT). Almost 40-50 % of those with IGT progress to T2D during their lifetime. Firstly, one should change her/ his Lifestyle Intervention
One of the earliest trials, Study 1:-The Da Qing study in China, demonstrated reduction in risk of T2D with diet, exercise or both, risk reduction by 31-46 %. Study 2:- The Finnish Diabetes Prevention Study (DPS) showed a risk reduction of 58 % at 4 years in the intervention group compared to controls. It involved 522 subjects and the intervention targeted at five goals; (1) modest weight loss of 5 %, (2) decrease fat intake to <30 %, (3) decrease saturated fat to <10 %, (4) increase fibre and (v), moderate physical activity of at least 30 min per day. Furthermore, the DPS demonstrated that the reduced risk was proportional to the number of lifestyle goals obtained.’ Study 3 :-The Diabetes Prevention Program (DPP)one of the largest randomized control trials, studied 3,234 American multiethnic obese subjects with IGT with a median follow-up of 2.8 years. It showed similar risk reduction of 58 % with intensive life style as in DPS. It has to be noted that in all the above trials, (the benefit persisted for several years after cessation of active intervention. Study 4:- The Indian Diabetes Prevention Program (IDPP) also showed that lifestyle and metformin independently reduced progression of IGT to T2 Dm though the above trials have proven that behavior modification can slow the progression to T2D. the intensive personal contact methods used by them may not be universally adaptable due to inadequate resources. Reassuringly,
a recent study in India has demonstrated that less expensive methods like mobile phone messaging can be successfully used to reduce the risk of T2D. Study 5 :-In this randomized controlled trial, lifestyle advice through regular text messaging was acceptable to the participants and reduced the risk of progression to T2D by 36 % over 2 years. As the study was conducted on working men with impaired glucose tolerance in an urban population, it remains to be seen if it is acceptable and effective in other populations. However it is an exciting prospect considering the rapid increase in mobile phone ownership, particularly in developing countries with poor health care infrastructure where the impact can be substantial.
Medications for overt DM:- No medication is licensed for use in, those people at high risk of diabetes.
Medications used in treatment of T2D and obesity have also been found useful in prevention, although all have significant side effects. Since not all people who are at risk of diabetes will develop diabetes it therefore becomes important to consider the risk-benefit ratio. Currently, in the UK and many' countries across the world, no medication is licensed for use in, those people at high risk of diabetes. Study 6 : Metformin at a dose of 1,700 mg/day was effective in DPP with 31 % risk reduction and the benefit was more pronounced in younger, more obese subjects and in women with prior gestational diabetes. Study 5(contd) :-The IDPP showed that metformin was also effective in a lower dose of 500 mg/day in reducing the progression to
T2D in Asian Indians. ;
Thiazolidinediones (troglitazone, rosiglitazone and pioglitazone) have proven very effective with a 50-70 % reduction m IGT conversion to diabetes in various trials, as has acarabose. though adverse effects are common.

What about orlistat ?? Orlistat in combination of lifestyle changes, reduced the progression to diabetes by 52 % when compared to lifestyle and placebo; however this drug was poorly tolerated by the participants.
What about Incretin based therapies (GLP-1 agonists and DPP-4 inhibitors) as a mode of prevention/ deferring DM?? Their role in prevention of T2D

remains largely to be explored) Such drugs are being increasingly used for their beneficial effects on weight and glycemic control in T2D, but their role in prevention of T2D

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