Prediction and prevention of type 2 diabetes.

Type 2 diabetes mellitus is one of the most costly and burdensome chronic diseases of our time and a condition that is increasing in epidemic proportions worldwide. Its complications are a significant cause of morbidity and mortality and a tremendous economic burden to the society. Effective prevention programs are therefore urgently needed. Some of the risk factors for the development of type 2 diabetes, such as obesity, physical inactivity and high-fat diet, can potentially be modified. Compelling evidence now exists from well designed randomized studies that the disease can be prevented or delayed in subjects at high risk for its development, i.e. subjects with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). The interventions studied include lifestyle modifications (with diet and exercise) and drug treatment. Weight loss with lifestyle modification seems to be the most effective way so far, given the fact that it addresses other cardiovascular disease risk factors as well. The big challenge we are facing now is to try to implement these findings in our society or among our high-risk patients, taking into consideration the great difficulties involved in changing lifestyle and in maintaining lifestyle modifications.