title: We can change the natural history of type 2 diabetes.
abstract: As diabetes develops, we currently waste the first ∼10 years of the natural history. If we found prediabetes and early diabetes when they first presented and treated them more effectively, we could prevent or delay the progression of hyperglycemia and the development of complications. Evidence for this comes from trials where lifestyle change and/or glucose-lowering medications decreased progression from prediabetes to diabetes. After withdrawal of these interventions, there was no "catch-up"-cumulative development of diabetes in the previously treated groups remained less than in control subjects. Moreover, achieving normal glucose levels even transiently during the trials was associated with a substantial reduction in subsequent development of diabetes. These findings indicate that we can change the natural history through routine screening to find prediabetes and early diabetes, combined with management aimed to keep glucose levels as close to normal as possible, without hypoglycemia. We should also test the hypothesis with a randomized controlled trial.
authors.affiliation: Atlanta VA Medical Center, Decatur, GA Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA lawrence.phillips@emory.edu.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
authors.affiliation: American Diabetes Association, Alexandria, VA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ratner
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: John B
authors.initials: JB
authors.lastname: Buse
authors.affiliation: VA Puget Sound Health Care System, Seattle, WA Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Kahn
mesh_terms: D048909:Diabetes Complications / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D019468:Disease Management; D018450:Disease Progression; D042241:Early Diagnosis; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents