Preventing type 2 diabetes in high risk patients: an overview of lifestyle and pharmacological measures.
BACKGROUND
Type 2 diabetes mellitus (T2DM) is a common disease that is associated with an increased risk of vascular complications. The incidence of T2DM is also increasing. It follows that T2DM prevention is important.


METHODS
Relevant articles (review articles, randomised studies and large cohort and case-control studies) were identified through a Medline search (up to March 2005).


RESULTS
The first trials on T2DM prevention were based on lifestyle intervention. The results of these studies were impressive since they demonstrated that even a small reduction in weight could significantly reduce the incidence of T2DM. However, the main disadvantage of lifestyle measures is that they are difficult to achieve and sustain. Therefore, pharmacological interventions have also been evaluated. The results of trials using metformin, orlistat, nateglinide, acarbose, thiazolidinediones, hormone replacement therapy, statins or fibrates are either encouraging or require more extensive evaluation. In addition, studies using antihypertensive drugs (mainly angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists) showed that these drugs could also reduce the progression to T2DM in high risk individuals.


CONCLUSIONS
T2DM has major quality of life and cost implications. Therefore, more research is needed to establish safe and cost effective ways to prevent this modern epidemic.
Liberopoulos
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EN
Dept. of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital, Royal Free and University College School of Medicine, Pond Street, London NW3 2QG, UK.
Tsouli
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Mikhailidis
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DP
Elisaf
M S
MS
D019440:Anti-Obesity Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001835:Body Weight / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008019:Life Style; D012306:Risk
D019440:Anti-Obesity Agents; D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents