Societal Perspectives on Preventing Type 2 Diabetes

Michael Engelgau, MD, MS

Reviewed by Joelle Escoffery, PhD

A number of large randomized research trials have demonstrated the effectiveness of lifestyle modification and, to a lesser degree, pharmacologic therapies such as metformin, acarbose, and troglitazone (no longer available), for the primary prevention of type 2 diabetes. These results point to the beneficial nature of screening for type 2 diabetes, but the most effective screening strategies still need to be determined. The major randomized trials have primarily studied people with impaired glucose tolerance who are also overweight, leaving a gap in the understanding of the effectiveness of primary prevention among people with isolated impaired fasting glucose and normal weight people. Two different approaches to screening are currently used.  The first strategy is to detect prediabetes or overt type 2 diabetes by measuring blood glucose directly. The American Diabetes Association’s diagnostic criteria for prediabetes was recently lowered from a fasting blood glucose level of 110 mg/dL to 100 mg/dL, increasing the number of people who will receive a diagnostic label by this approach. The second strategy is to use easily available information to create a risk factor profile. When designing a detection program, program goals, available health care information, and the target population need to be considered.