True diabetes prevention lies not in maintaining a pre-diabetes state but rather in moving from prediabetes to normal glucose regulation, Dr. Leigh Perreault from the University of Colorado in Aurora and colleagues say.
They add that weight loss and intensive lifestyle modification can help with this goal even in the presence of age-related changes.
In fact, based on a study in the September issue of Diabetes Care, researchers — all members of the Diabetes Prevention Program Research Group — advise, “Weight loss appears to be the most important component of intensive lifestyle modification predicting regression, with every 1 kg lost associated with a 16% reduction in prediabetes risk.”
To better understand the effects of basal biological factors, weight change, and preventive strategies on the incidence of regression from prediabetes to normal glucose regulation, the researchers analyzed data on 2,528 subjects in the Diabetes Prevention Program clinical trial. Each had been randomized to one of three study arms: intensive lifestyle modification, 850 mg of metformin twice daily plus standard lifestyle advice, or placebo twice daily plus standard lifestyle advice.
During three years of follow-up, a lower baseline fasting and 2-hour glucose, younger age, greater insulin secretion to an oral glucose load, intensive lifestyle modification, and weight loss were independently associated with regression from prediabetes to normal glucose regulation.
Metformin use, male sex, and greater insulin sensitivity showed a trend for an effect on regression from prediabetes to normal glucose regulation.
Higher fasting and lower 2-hour glucose, male sex, and greater insulin sensitivity were associated with regression from prediabetes to isolated impaired fasting glucose, the researchers note.
Furthermore, lower fasting and higher 2-hour glucose, female sex, greater insulin secretion, intensive lifestyle modification, and metformin use were associated with regression from prediabetes to isolated impaired glucose tolerance.
“Some factors governing the return to normal glucose regulation are modifiable, and others are not,” the authors conclude. “Establishing healthy habits early in life, before age-related changes occur, is most likely the best strategy for diabetes prevention.”