Prevention of Type 1 DM
Type 1 DM results from the destruction of the insulin-producing pancreatic islet cells due to autoimmune disease. Identification of Type 1 DM cannot occur until the signs and symptoms of DM occur, by which time most of the islet cells have already been destroyed. Immunosuppressive or anti-inflammatory therapy for Type 1 DM is still in the research stage. With destruction of islet cells underway, Type 1 DM is difficult to slow down. The experimental nature of autoimmune therapy and the difficulty in pinpointing the onset of the illness makes prevention unfeasible. The genetic basis for Type 1 DM makes watchful waiting the only strategy for those at risk.
Prevention of Type 2 DM
Identifying those at risk is the first step of preventing Type 2 DM. Identifying susceptible individuals is by determining the hemoglobin A1c or fasting plasma glucose annually in persons >45 years of age who have a BMI>25 kg/m2 and who have one or more additional risk factors for diabetes:
- Abnormal glucose metabolism (fasting plasma glucose 100-125 mg/dL, 2-hour OGTT result >140, or A1c 5.7 -o 6.4 %).
- Family history of diabetes mellitus in a first-degree relative
- Sedentary lifestyle
- History of gestational diabetes (women)
- Dyslipidemia (high triglycerides, low HDL-cholesterol, elevated LDL-cholesterol)
The metabolic syndrome encompasses these risk factors.
Prevention via lifestyle modification includes exercise, weight loss, a healthy diet, and smoking cessation. The benefits of lifestyle modification persist for three years or more for those with “pre-diabetes” (the elevations cited above for glucose, OGTT, and A1c levels).
Oral hypoglycemics are used in those at risk, with metformin (850 mg. twice daily) added in conjunction with the lifestyle changes.