title: Preventing diabetes in the clinical setting.
abstract: OBJECTIVE
  Translating lessons from clinical trials on the prevention or delay of type 2 diabetes to populations in nonstudy settings remains a challenge. The purpose of this paper is to review, from the perspective of practicing clinicians, available evidence on lifestyle interventions or medication to prevent or delay the onset of type 2 diabetes.
  
  
  METHODS
  A MEDLINE search identified 4 major diabetes prevention trials using lifestyle changes and 3 using prophylactic medications. We reviewed the study design, key components, and outcomes for each study, focusing on aspects of the interventions potentially adaptable to clinical settings.
  
  
  RESULTS
  The lifestyle intervention studies set modest goals for weight loss and physical activity. Individualized counseling helped participants work toward their own goals; behavioral contracting and self-monitoring were key features, and family and social context were emphasized. Study staff made vigorous follow-up efforts for subjects having less success. Actual weight loss by participants was modest; yet, the reduction in diabetes incidence was quite significant. Prophylactic medication also reduced diabetes risk; however, lifestyle changes were more effective and are recommended as first-line strategy. Cost-effectiveness analyses have shown both lifestyle and medication interventions to be beneficial, especially as they might be implemented in practice.
  
  
  CONCLUSIONS
  Strong evidence exists for the prevention or delay of type 2 diabetes through lifestyle changes. Components of these programs may be adaptable for use in clinical settings. This evidence supports broader implementation and increased reimbursement for provider services related to nutrition and physical activity to forestall morbidity from type 2 diabetes.
authors.affiliation: Section of General Internal Medicine, Department of Medicine. Diabetes Research and Training Center, The University of Chicago, Chicago, IL 60637, USA. dburnet@medicine.bsd.uchicago.edu
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Burnet
authors.forename: Lorrie D
authors.initials: LD
authors.lastname: Elliott
authors.forename: Michael T
authors.initials: MT
authors.lastname: Quinn
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Plaut
authors.forename: Mindy A
authors.initials: MA
authors.lastname: Schwartz
authors.forename: Marshall H
authors.initials: MH
authors.lastname: Chin
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000188:drug therapy / Q000517:prevention & control*; D004038:Diet, Reducing; D015444:Exercise; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008019:Life Style; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D040242:Risk Reduction Behavior; D015431:Weight Loss
chemical_list: D007004:Hypoglycemic Agents