Point: If It Is Important to Prevent Type 2 Diabetes, It Is Important to Consider All Proven Therapies Within a Comprehensive Approach

Abstract

Type 2 diabetes is a common metabolic disease that is defined on the basis of glucose levels above specific thresholds. Individuals with type 2 diabetes are at high risk of blindness, renal failure, amputation, cardiovascular disease, premature death, dementia, and a variety of other chronic diseases and life-threatening events. However, unlike other risk factors for future events (e.g., hyperlipidemia or hypertension), type 2 diabetes is often associated with symptoms and discomfort related to elevated glucose levels that range from fatigue, nocturia, polyuria, and nonspecific aches and pains to dehydration and coma. Moreover, once diabetes is diagnosed, affected individuals incur additional cost and inconvenience related to disease labeling, dietary and lifestyle modification, glucose monitoring, eye assessments, and higher health and life insurance premiums. Several trials have shown that aggressive management of type 2 diabetes can reduce the risk of microvascular disease (1–3), and that multifactorial risk factor interventions can reduce the risk of these and other consequences (4–6). These considerations and epidemiologic evidence that the risk of eye and kidney disease is well below the diagnostic thresholds for diabetes suggest that if glucose levels are prevented from rising past these thresholds, or the rise is delayed, these consequences will also be prevented or delayed. Moreover, evidence that the glucose level is a progressive risk factor for cardiovascular events (i.e., that the risk rises with the glucose level) (7–11) supports the hypothesis that preventing or delaying any rise within the nondiabetic range may reduce the risk of cardiovascular events. Finally, if ongoing clinical trials (12 …