Early epidemiological and clinical trials suggested that type 2 diabetes could be prevented or delayed by lifestyle modifications. The Finnish Diabetes Prevention Study and the Diabetes Prevention Programs provided conclusive evidence that type 2 diabetes could be prevented or delayed with modest lifestyle changes—5% to 7% loss of body weight and 150 min/week of physical activity. Both used intensive intervention strategies and continued support and follow-up to achieve study goals. Other smaller studies made similar observations. Various medications—metformin, acarbose, troglitazone and pioglitazone, orlistat, and rosiglitazone—and bariatric surgery have also been effective for the prevention or delay of diabetes. Nutrient factors studied include the contribution of a high dietary fat intake, especially saturated fat, to the development of diabetes and increased intake of fiber, whole grains, and alcohol to decreased risk. A review of the evidence led the American Diabetes Association to conclude that lifestyle interventions should be the first choice for prevention or delay of diabetes and that drug therapy should not be a substitute for lifestyle interventions—healthy and appropriate food choices and physical activity.
World Health Organization. Preventing Chronic Diseases: A Vital Investment. Geneva, Switzerland: WHO Press; 2005.
2.
Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2005. Atlanta, Ga: Department of Health and Human Services, Centers for Disease Control and Prevention; 2005.
3.
Utzschneider KM, Carr DB, Hull RL, et al. Impact of intra-abdominal fat and age on insulin sensitivity and beta-cell function. Diabetes. 2004;53:2867-2872.
4.
Wing RR. Lifestyle and the prevention of diabetes. In: Franz MJ, Bantle JP, eds. American Diabetes Association Guide to Medical Nutrition Therapy for Diabetes. Alexandria, Va: American Diabetes Association; 1999:351-368.
5.
Colditz GA, Willett WC, Stampfer MJ, et al. Weight gain as a risk factor for clinical diabetes in women. Am J Epidemiol. 1990;132:501-513.
6.
Knowler WC, Pettitt DJ, Savage PJ, Bennett PH. Diabetes incidence in Pima Indians: contributions of obesity and parental diabetes. Am J Epidemiol. 1981;113:144-156.
7.
Ohlson LO, Larsson B, Bjorntorp P, et al. Risk factors for type 2 diabetes (non-insulin-dependent) diabetes mellitus: thirteen and one-half years of follow-up of the participants in a study of Swedish men born in 1913. Diabetologia. 1988;31:798-805.
8.
Everhart JE, Pettitt DJ, Bennett PH, Knowler WC. Duration of obesity increases the incidence of NIDDM. Diabetes. 1992;41:235-240.
9.
Manson JE, Spelsberg A. Primary prevention of non-insulin-dependent diabetes mellitus. Am J Prev Med. 1994;10:172-184.
10.
Moore LL, Visioni AJ, Wilson PWF, et al. Can sustained weight loss in overweight individuals reduce the risk of diabetes mellitus?Epidemiology. 2000;11:269-273.
11.
Viswanathan M, Snehalatha C, Viswanathan V, et al. Reduction in body weight helps to delay the onset of diabetes even in non-obese with strong history of the disease. Diabetes Res Clin Pract. 1997;35:107-112.
12.
Helmrich SP, Ragland DR, Leung RW, et al. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med. 1991;325:147-152.
13.
Manson JE, Rimm EB, Stampfer MJ, et al. Physical activity and incidence of non-insulin-dependent diabetes in women. Lancet. 1991;338:774-778.
14.
Manson JE, Nathan DM, Krolewski AS, et al. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA. 1992;268:63-67.
15.
Eriksson KG, Lindgäde F. Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. Diabetologia. 1991;34:891-891.
16.
Page RCL, Harnden KE, Cook JTE, et al. Can lifestyles of subjects with impaired glucose tolerance be changed? A feasibility study. Diabetic Med. 1992;9:562-566.
17.
Bourn DM, Mann JI, McSkimming BJ, et al. Impaired glucose tolerance and NIDDM: does a lifestyle intervention program have an effect?Diabetes Care. 1994;17:1311-1319.
18.
Bourn DM, Mann JI. The 3-year follow-up of subjects with impaired glucose tolerance or non-insulin dependent diabetes mellitus in a diet and exercise intervention programme. Diabetes Nutr Metab. 1996;9:240-246.
19.
Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. Diabetes Care. 1997;20:537-544.
20.
Wing RR, Venditti EM, Jakicic JM, et al. Lifestyle intervention in overweight individuals with a family history of diabetes. Diabetes Care. 1998;21:350-359.
21.
Wenying Y, Lixiang L, Jinwu Q, et al. The preventive effect of acarbose and metformin on the progression to diabetes mellitus in the IGT population: a 3-year multi-center prospective study. Chin J Endocrinol Metab. 2001;17:131-136.
22.
Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;322:1343-1350.
23.
Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
24.
Lindström J, Louheranta A, Mannelin M, et al. The Finnish Diabetes Prevention Study (FDS): lifestyle intervention and 3-year results of diet and physical activity. Finnish Diabetes Prevention Study Group. Diabetes Care. 2003;26:3230-3236.
25.
Laaksonen DE, Lindström J, Lakka TA, et al. Physical activity in the prevention of type 2 diabetes. Diabetes. 2005;54:158-165.
26.
Ratner R, Goldberg R, Haffner S, et al. Impact of lifestyle intervention metformin therapy on cardiovascular disease risk factors in the Diabetes Prevention Program. Diabetes Care. 2005;28:888-894.
27.
Herman WH, Hoerger TJ, Brandle M, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142:323-332.
28.
Eddy DM, Schlessinger L, Kahn R. Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes. Ann Intern Med. 2005;143:251-264.
29.
Kosaka N, Noda M, Kuzuya T. Prevention of type 2 diabetes by lifestyle intervention: a Japanese trial in IGT males. Diabetes Res Clin Pract. 2005;67:152-162.
30.
Chiasson J-L, Brindisi M-C, Rabasa-Lhoret R. The prevention of type 2 diabetes: what is the evidence?Minerva Endocrinol. 2005;30:179-191.
31.
Chiasson J-L, Josse RG, Gomis R, et al, and the STOP-NIDDM Trial Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomized trial. Lancet. 2002;359:2072-2077.
32.
Buchannan TA, Xiang AH, Peters RK, et al. Preservation of pancreatic beta-cell function and the prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk Hispanic women. Diabetes. 2002;51:2796-2803.
33.
Knowler WC, Hamman RF, Edelstein SL, et al. Prevention of type 2 diabetes with troglitazone in the Diabetes Prevention Program. Diabetes. 2005;54:1150-1156.
34.
Xiang AH, Peters RK, Kjos SL, et al. Effect of pioglitazone on pancreatic beta-cell function and diabetes risk in Hispanic women with prior gestational diabetes. Diabetes. 2006;55:517-522.
35.
Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L. Xenical in the Prevention of Diabetes in Obese Subjects (XENDOS) study. Diabetes Care. 2004;27:155-161.
36.
The DREAM (Diabetes REduction Assessment with Ramipril and Rosiglitazone Medication) Trial Investigators. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomized controlled trial. Lancet. 2006;368:1096-1105.
37.
Sjoström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683-2693.
38.
Long SD, O'Brien K, MacDonald KG Jr, et al. Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. Diabetes Care. 1994;17:372-375.
39.
Guidone C, Manco M, Valera-Mora E, et al. Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery. Diabetes. 2006;55:2025-2031.
40.
van Dam RM, Willett WC, Rimm EB, et al. Dietary fat and meat intake in relation to risk for type 2 diabetes in men. Diabetes Care. 2002;25:417-424.
41.
Vessby B, Unsitupa M, Hermansen K, et al. Substituting dietary saturated fat for monounsaturated fat impairs insulin sensitivity in healthy men and women. Diabetologia. 2001;44:312-319.
42.
Louheranta AM, Schwab US, Sarkkinen ES. Insulin sensitivity after a reduced-fat diet and a monene-enriched diet in subjects with elevated serum cholesterol and triglyceride concentrations. Nutr Metab Cardiovasc Dis. 2000;10:177-187.
43.
Maron DJ, Fair JM, Haskell WL. Saturated fat intake and insulin resistance in men with coronary artery disease. Circulation. 1991;84:2070-2074.
44.
Lovejoy JC. The infl uence of dietary fat on insulin resistance. Curr Diab Rep. 2002;2:435-440.
45.
Clark SD. Polyunsaturated fatty acid regulation of gene transcription: a mechanism to improve energy balance and insulin resistance. Br J Nutr. 2000;83(suppl 1):S59-S66.
46.
Meyer KA, Kushi LH, Jacobs DR Jr, et al. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr. 2000;71:921-930.
47.
Liu S, Manson JE, Stampfer MJ, et al. A prospective study of whole-grain intake and risk of type 2 diabetes mellitus in US women. Am J Pub Health. 2000;90:1409-1415.
48.
Schulze MG, Liu S, Rimm EB, et al. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr. 2004;80:348-356.
49.
Stevens J, Ahn K, Juhaeri, et al. Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the ARIC study. Diabetes Care. 2002;25:1715-1721.
50.
Jensen MK, Koh-Banerjee P, Franz M, et al. Whole grains, bran, and germ in relation to homocysteine and markers of glycemic control, lipids, and inflammation. Am J Clin Nutr. 2006;83:275-283.
51.
Liese AD, Roach AK, Sparks KC, et al. Whole-grain intake and insulin sensitivity: the Insulin Resistance and Atherosclerosis Study. Am J Clin Nutr. 2003;78:965-971.
52.
Mayer-Davis EJ, Dhawan A, Liese AD, et al. Towards understanding of glycemic index and glycemic load in habitual diet: associations with glycemia in the Insulin Resistance Atherosclerosis Study. Br J Nutr. 2006;95:397-405.
53.
Salmeron J, Manson JE, Stampfer MJ, et al. Dietary fiber, glycemic load, and risk of no-insulin-dependent diabetes mellitus in women. JAMA. 1997;277:472-277.
54.
Salmeron J, Ascherio A, Rimm EB, et al. Dietary fiber, glycemic load and risk of NIDDM in men. Diabetes Care. 1997;20:545-550.
55.
van Dam RM, Visscher AW, Feskens EJ, et al. Dietary glycemic index in relation to metabolic risk factors and incidence of coronary heart disease: the Zutphen Elderly Study. Eur J Clin Nutr. 2000;54:726-731.
56.
Lau C, Faerch K, Gl mer C, et al. Dietary glycemic index, glycemic load, fiber, simple sugars, and insulin resistance: the Inter99 study. Diabetes Care. 2005;28:1397-1403.
57.
Liese A, Schulz M, Fang F, et al. Dietary glycemic index, glycemic load, carbohydrate and fiber intake and measures of insulin sensitivity, secretion, and adiposity in the Insulin Resistance and Atherosclerosis Study. Diabetes Care. 2005;28:2832-2838.
58.
McKeown NM, Meigs JB, Liu S, et al. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 2004;27:538-546.
59.
Franz MJ. The argument against glycemic index: what are the other options? In: Bantle JP, Slama G, eds. Management of Diabetes Mellitus and Dysmetabolic Syndrome. Vol. 11. Nestlé Nutr Workshop Ser Clin Perform Program. Basel, Switzerland: Nestec Ltd, Vevey/S. Karger AG; 2006:57-72.
60.
Sheard NF, Clark NG, Brand-Miller JC, et al. Dietary carbohydrate (amount and type) in the prevention and management of diabetes. A statement of the American Diabetes Association. Diabetes Care. 2004;27:2266-2271.
61.
Howard AA, Arnsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med. 2004;140:211-219.
62.
Koppes LLJ, Dekker JM, Hendriks HFJ, Bouter LM, Heine RJ. Moderate alcohol consumption lowers the risk of type 2 diabetes. Diabetes Care. 2005;28:719-725.
63.
Davies MJ, Baer DJ, Judd JT, et al. Effects of moderate alcohol intake on fasting insulin and glucose concentrations and insulin sensitivity in postmenopausal women. JAMA. 2002;287:2559-2562.
64.
Ellison RC, Zhang Y, Qureshi MM, et al. Lifestyle determinants of high-density lipoprotein cholesterol: the National Heart, Lung, and Blood Institute Family Heart Study. Am Heart J. 2004;147:529-535.
65.
Rimm EB, Klatasky A, Grobbee A, Stumpfer MJ. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits?BMJ. 1996;312:731-736.
66.
American Diabetes Association and National Institute of Diabetes, Digestive and Kidney Disease. The prevention or delay of type 2 diabetes (position statement). Diabetes Care. 2002;25:742-749.
67.
American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2006;29:2140-2157.
