Into the future: prevention of diabetes.

With the increasing prevalence of obesity and an aging population, type 2 diabetes mellitus (T2DM) is rapidly becoming the most common chronic disease in the US. In the US alone, over 1.5 million new cases by the Center for Disease Control are diagnosed per year. Concomitant with the rising epidemic in diabetes are the resulting severe complications such as renal and cardiac dysfunction, amputations, impairment in vision and increased mortality. Since T2DM has such an enormous cost in terms of quality of life and mortality as well as economic cost, prevention of T2DM is an important and appropriate target. Interventions for T2DM range from lifestyle modifications such as weight loss and diet to pharmacological agents and surgical intervention such as bariatric surgery. Of the various lifestyle modifications studied, weight loss has consistently been shown to be an effective mechanism of T2DM prevention. Regarding dietary interventions, only the increased consumption of green, leafy vegetables reduces the risk of T2DM in contrast to the popular belief that a diet high in fruits and vegetables reduces this risk. Pharmacological agents investigated in preventing diabetes primarily target the same pathological pathways found in T2DM. Metformin has consistently been shown to reduce the incidence of T2DM and improve impaired glucose tolerance. α2-Glucosidase inhibitors are also effective in prevention of T2DM, but are limited by their gastrointestinal side effects. Interestingly, although ramipril showed no effect on development of diabetes, valsartan did reduce the incidence of diabetes in patients with impaired glucose tolerance and cardiovascular disease. Although single intervention studies are important in delineating whether an intervention or agent is effective, a multi-faceted approach has been shown to be more effective. Importantly, such an approach is pragmatic and urgently needed to stem the tide of T2DM and its significant human and financial cost.