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Aggressive treatment of pre-diabetes could reduce progression to diabetes

Treating pre-diabetes aggressively with intensive lifestyle intervention could be an effective way to significantly reduce the chances of of a person progressing to type 2 diabetes later in life.

Pre-diabetes is increasing worldwide – it is projected that more than 470 million people will have pre-diabetes by 2030. About 5–10% of those with pre-diabetes will progress to type 2 diabetes each year.

The Diabetes Prevention Program Outcomes Study (DPPOS) is a long-term observational follow-up study monitoring 2761 people with a high risk of developing diabetes who had been enrolled in the Diabetes Prevention Programme (DPP). Participants formerly randomly assigned to lifestyle intervention, metformin and placebo groups were followed up for a median 5.7 years during DPPOS. 

All participants were offered group-implemented lifestyle sessions before the start of DPPOS, including those who had been randomly assigned to the intensive lifestyle group during DPP. Those who were on metformin initially continued, unless there was a reason for discontinuation.

In the research, published in The Lancet on 16 June, the authors found a 56% reduction in diabetes incidence in high-risk individuals who achieved normal blood glucose at any point during DPP, no matter how this reversion was achieved or however transiently.

Diabetes risk was highest in participants who still had pre-diabetes despite lifestyle intervention. The researchers noted that this finding emphasises a particular susceptibility in this group, who might benefit from additional interventions. They added that these data serve as essential clinical information to support early and aggressive measures for long-term prevention of diabetes in people at risk.

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