The role of lifestyle interventions in preventing diabetes in high risk populations

Abstract

Diabetes mellitus (DM) represents a group of metabolic disorders characterized by hyperglycemia that produces long-term dysfunctions, at many levels, especially in the eyes, kidneys, cord, blood vessels and nervous system. Through its microvascular (retinopathy, nephropathy, neuropathy) and macrovascular complications (myocardial infarction, stroke, peripheral arterial disease), diabetes is a major cause of increased morbidity and reduced quality of life and life expectancy.
If in 2000 the prevalence of diabetes worldwide was 2.8% (171 million people) it is projected that in 2030 the prevalence of diabetes will be 4.4% (366 million people). It thus justifies the growing interest for early diagnosis and active screening of patients with DM, which is the first step to implementing early intervention, primary prevention of this disease being a goal of major interest.
In recent years it increasingly emerged the idea of excess metabolic and cardiovascular risk in patients currently considered normo-glycemic but with a high value of 1 hour post load blood glucose in the oral glucose tolerance test OGTT. Several studies have investigated the hypothesis that subjects with normal glucose tolerance and 1hour blood glucose in OGTT as high as patients with impaired glucose tolerance (IGT) is an intermediate category of patients presenting an altered metabolism translated by increased insulin resistance and reduced β cell susceptibility to glucose.
Cardiovascular risk and the subsequent risk of the development of DM in this group of patients was found to be equal to that of patients diagnosed with IGT by current standards. These subjects at increased risk for future type 2 diabetes are the ones that effective prevention programs target.
There are overwhelming data that prove the fact that lifestyle modifications, both diet and multiple physical activity are highly successful in preventing diabetes and cardiovascular morbidity in high-risk populations. Clinical guidelines are needed for the optimal community implementation of evidence-based diabetes prevention programs.

Key words:

diabetes, oral glucose tolerance test, one hour glucose, early prevention

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