title: Update and Next Steps for Real-World Translation of Interventions for Type 2 Diabetes Prevention: Reflections From a Diabetes Care Editors' Expert Forum.
abstract: The International Diabetes Federation estimates that 415 million adults worldwide now have diabetes and 318 million have impaired glucose tolerance. These numbers are expected to increase to 642 million and 482 million, respectively, by 2040. This burgeoning pandemic places an enormous burden on countries worldwide, particularly resource-poor regions. Numerous landmark trials evaluating both intensive lifestyle modification and pharmacological interventions have persuasively demonstrated that type 2 diabetes can be prevented or its onset can be delayed in high-risk individuals with impaired glucose tolerance. However, key challenges remain, including how to scale up such approaches for widespread translation and implementation, how to select appropriately from various interventions and tailor them for different populations and settings, and how to ensure that preventive interventions yield clinically meaningful, cost-effective outcomes. In June 2015, a Diabetes Care Editors' Expert Forum convened to discuss these issues. This article, an outgrowth of the forum, begins with a summary of seminal prevention trials, followed by a discussion of considerations for selecting appropriate populations for intervention and the clinical implications of the various diagnostic criteria for prediabetes. The authors outline knowledge gaps in need of elucidation and explore a possible new avenue for securing regulatory approval of a prevention-related indication for metformin, as well as specific considerations for future pharmacological interventions to delay the onset of type 2 diabetes. They conclude with descriptions of some innovative, pragmatic translational initiatives already under way around the world.
authors.affiliation: Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.
authors.forename: William T
authors.initials: WT
authors.lastname: Cefalu
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: John B
authors.initials: JB
authors.lastname: Buse
authors.affiliation: Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Dasman Diabetes Institute, Dasman, Kuwait; Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; and Center for Vascular Prevention, Danube University Krems, Krems, Austria.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Tuomilehto
authors.affiliation: Kinexum, Harpers Ferry, WV.
authors.forename: G Alexander
authors.initials: GA
authors.lastname: Fleming
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Ele
authors.initials: E
authors.lastname: Ferrannini
authors.affiliation: McMaster University and Hamilton Health Sciences, Hamilton, Canada.
authors.forename: Hertzel C
authors.initials: HC
authors.lastname: Gerstein
authors.affiliation: National Institutes of Health, Phoenix, AZ.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Bennett
authors.affiliation: India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Ambady
authors.initials: A
authors.lastname: Ramachandran
authors.affiliation: Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Raz
authors.affiliation: Dallas Diabetes and Endocrine Center at Medical City and The University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Julio
authors.initials: J
authors.lastname: Rosenstock
authors.affiliation: VA Puget Sound Health Care System and University of Washington, Seattle, WA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Kahn
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D018149:Glucose Intolerance / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008019:Life Style; D008687:Metformin / Q000627:therapeutic use; D011236:Prediabetic State / Q000188:drug therapy
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin