Ch5_ReducingRisk

7/28/2019 Ch5_ReducingRisk

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Reducing the Risk of Developing

DiabetesChapter 5

Thomas Ransom, Ronald Goldenberg, Amanda Mikalachki,

Ally PH Prebtani, Zubin Punthakee

Canadian Diabetes Association

2013 Clinical Practice Guidelines



guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.ca

Copyright © 2013 Canadian Diabetes Association

Key Points

1. At this time, there are no safe and effective

strategies to prevent T1DM

2. Intensive lifestyle modification with weight loss

can reduce the risk of progression from pre-diabetes

to T2DM by almost 60%

3. Progression from pre-diabetes to T2DM can be

reduced by Metformin or Acarbose byapproximately 30%

2013





No Safe and Effective Strategies to Prevent

T1DM at this Time• T1DM is a chronic autoimmune condition with destruction of

pancreatic beta cells

• Ongoing or completed trials –

ENDIT: High-dose nicotinamide – Not effective – DPT-1: Low-dose insulin in high risk relatives – Not effective

overall

– TRIGR: Exclusion of cow’s milk protein to infants until 6-8 months

of age – Trial ongoing

• Alternate strategy to use immunosuppression / modulation

at the time of diagnosis but significant side effects and

ethical considerations





Diabetes Prevention Program (DPP)

Diabetes Prevention Program (DPP) Research Group. N Engl J Med 2002;346:393-403.

Years

• Benefit of diet and exercise or Metformin on diabetes prevention in

at-risk patients• N = 3234 with IFG and IGT, without diabetes

0

0

10

20

30

40

1.0 2.0 3.0 4.0

Placebo

Metformin

Lifestyle

Cumulativeincidence of

diabetes

(%)

↓31%

↓58%

P*< 0.001

< 0.001

*vs placebo

IFG = impaired fasting glucose,

IGT = impaired glucose tolerance





STOP-NIDDM Study

Effects of Acarbose on the risk of T2DM

C

hiasson JL, et al. Lancet 2002;359:2072-77.

N = 1429 people with IGT, BMI 25-40, 40-70 yrs, 3.3 years follow up

Days after randomization

C u m

u l a t i v e p r o b a b i l i t y

P = 0.0022

Acarbose

Placebo

1.00

0.95

0.90

0.500.45

0.40

0.65

0.60

0.55

0.800.75

0.70

0.85

Acarbose

↓25%





Pharmacology to Reduce Progression to

T2DM

• Metformin has been shown to reduce the incidence

of T2DM by approximately 30% in the Diabetes

Prevention Program (DPP)

• Acarbose has been shown to reduce the risk of

progression to diabetes by approximately 30% in

the Study to Prevent Non-Insulin Dependent

Diabetes (STOP-NIDDM) study





Recommendation 1 and 2

1. A structured program of lifestyle modification that

includes moderate weight loss and regular

physical activity should be implemented to reduce

risk of T2DM in individuals with IGT [Grade A, Level 1A] or

IFG [Grade B, Level 2] or A1C 6.0-6.4% [Grade D, consensus].

2. In individuals with IGT, pharmacologic therapy with

Metformin [Grade A, Level 1A] or Acarbose [Grade A, level 1A]

may be used to reduce the risk of T2DM.

2013





CDA Clinical Practice Guidelines

http://guidelines.diabetes.ca – for professionals

1-800-BANTING (226-8464)

http://diabetes.ca – for patients

http://guidelines.diabetes.ca/

http://diabetes.ca/

http://diabetes.ca/

http://guidelines.diabetes.ca/

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Ch5_ReducingRisk