Combined Pharmacologic/Nonpharmacologic Intervention in Individuals at High Risk of Developing Type 2 Diabetes

Abstract

The prevalence of type 2 diabetes continues to grow, and it is predicted that, unless effective prevention and control measures are implemented, the global prevalence of the disease will exceed 366 million by 2030 (1). Type 2 diabetes is associated with considerable morbidity, excess mortality, and substantial costs (2–4). A recent statement issued by the American Diabetes Association estimates that in the U.S., the cost of diabetes in 2007 was $174 million. However, the actual national burden is likely to exceed this figure because it does not include the social costs of intangibles such as care provided by nonpaid caregivers. Overall costs are expected to increase further because of the projected rise in the proportion of the population over the age of 65 years. Therefore, if successful, early intervention to delay or prevent the development of diabetes offers enormous potential benefit to individuals, health care systems, and society. Current diagnostic criteria for overt diabetes include a fasting plasma glucose concentration of ≥126 mg/dl or a 2-h postchallenge plasma glucose concentration of ≥200 mg/dl during a 75-g oral glucose tolerance test (5). The term “pre-diabetes” has recently been adopted to describe conditions in which blood glucose levels are elevated, but not above the American Diabetes Association–defined level for diabetes; it includes the presence of impaired fasting glucose (fasting plasma glucose concentration of 100–125 mg/dl) and/or impaired glucose tolerance (a 2-h post-challenge plasma glucose concentration of 140–199 mg/dl) (6). Most individuals with pre-diabetes will eventually develop overt diabetes. In the American Diabetes Prevention Program (DPP), the annual rate of development of diabetes in subjects who had impaired glucose tolerance or impaired fasting glucose was ∼10% (7). There is evidence that microvascular disease typically associated with diabetes is also observed in individuals with impaired glucose tolerance (8). A recent analysis …