Monday, April 30, 2007

International Diabetes Federation (IDF): Consensus statement on Type 2 diabetes prevention

International Diabetes Federation (IDF): Consensus statement on Type 2 diabetes prevention

The International Diabetes Federation (IDF) has issued a consensus statement on the prevention of type 2 diabetes in both the developed and the developing world. The consensus statement advises that prevention of Type 2 diabetes is based on controlling modifiable risk factors and can be divided into two target groups:

  • People at high risk of developing Type 2 diabetes
  • The entire population
In planning national measures for the prevention of Type 2 diabetes, it is recommended that both groups should be targeted simultaneously with lifestyle modification the primary goal through a stepwise approach. For identifying people at high risk, the IDF recommends the use of opportunistic screening by health-care personnel including those working in general practice, nurses and pharmacists.

The IDF recommends that lifestyle modification should be the first choice to prevent or delay diabetes. With respect to drugs, the following is recommended (directly from source):
  • The IDF recommends that when lifestyle intervention alone has not achieved the desired weight loss, and/or improved glucose tolerance goals, as set by the health-care provider, metformin in the dose of 250–850 mg b.i.d. (depending on tolerance) should be considered as a diabetes prevention strategy (particularly in those aged less than 60 years with a BMI > 30 kg/m2 (greater than 27 kg/m2 in certain ethnic populations) and a FPG > 6.1 mmol/l or 110 mg/dl who do not have any contraindications).
  • Acarbose is also worthy of consideration for those who can tolerate it.
  • PPAR gamma agonists such as rosiglitazone have shown promising results, but concerns must remain about side-effects including weight gain and congestive heart failure as well as durability, and so we do not recommend them for routine use at present.
  • A further option for the obese might be orlistat.
  • Similarly, newer agents such as rimonabant show some promise, but long-term safety and specific diabetes preventive efficacy data are lacking and are not currently recommended for diabetes prevention in those at increased risk. The IDF working group awaits with interest the results of ongoing studies into newer therapies.

The announcement from the IDF is here; and the Consensus has been published in Diabetic Medicine 2007: 24; 451-63 (link to abstract, full text available free at time of posting)

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