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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPeople who have diabetes are 2 to 4 times more likely to develop cardiovascular disease (CVD) than those without diabetes [World Heart Federation. \u003Ca href=\u0022http:\/\/www.world-heart-federation.org\/cardiovascular-health\/cardiovascular-disease-risk-factors\/diabetes\/\u0022\u003Ehttp:\/\/www.world-heart-federation.org\/cardiovascular-health\/cardiovascular-disease-risk-factors\/diabetes\/\u003C\/a\u003E]. This article discusses the importance of diabetes prevention in the prevention of CVD and the efficacy of risk factor modification programs.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPeople who have diabetes are 2 to 4 times more likely to develop cardiovascular disease (CVD) than those without diabetes [World Heart Federation. \u003Ca href=\u0022http:\/\/www.world-heart-federation.org\/cardiovascular-health\/cardiovascular-disease-risk-factors\/diabetes\/\u0022\u003Ehttp:\/\/www.world-heart-federation.org\/cardiovascular-health\/cardiovascular-disease-risk-factors\/diabetes\/\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EJaakko Tuomilehto, MD, MA, PhD, Danube-University Krems, Krems, Austria, discussed the importance of diabetes prevention in the prevention of CVD and the efficacy of risk factor modification programs.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EA Powerfully Destructive Duo\u003C\/h2\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe main risk to health in undiagnosed type 2 diabetes mellitus (T2DM) is increased risk of CVD, in particular ischemic heart disease due to coronary atherosclerosis (macrovascular disease) [Waugh N et al. \u003Cem\u003EHealth Technol Assess\u003C\/em\u003E 2007]. Impaired glucose tolerance (IGT) is also associated with increased mortality due to ischemic heart disease [Eriksson KF, Lindgarde F. \u003Cem\u003EDiabetologia\u003C\/em\u003E 1998]. Cardiovascular (CV) events account for roughly 80% of deaths among patients with T2DM [Nelson SE. \u003Cem\u003ECurr Med Res Opin\u003C\/em\u003E 2011], and glucose disturbances are twice as common in patients with coronary artery disease as in the general population [Bartnik M et al. \u003Cem\u003EHeart\u003C\/em\u003E 2007].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPrevalence of Diabetes\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe prevalence and cost of T2DM are increasing nationwide and globally [Nelson SE. \u003Cem\u003ECurr Met Res Opin\u003C\/em\u003E 2011]. In the past decade in the United States, the incidence of newly diagnosed diabetes in adults has nearly doubled, from a rate of 4.8\/1000 in 1997 to 9.1\/1000 in 2007 [\u003Cem\u003EMMWR Morb Mortal Wkly Rep\u003C\/em\u003E 2008]. Globally, an estimated 2.8% of the population (171 million people) had diabetes in 2000; this number is expected to rise to 4.4% (366 million people) by 2030 [Wild S et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2004; Nelson SE. \u003Cem\u003ECurr Med Res Opin\u003C\/em\u003E 2011].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPrevention is Key\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ET2DM is increasingly common, primarily because of increases in the prevalence of sedentary lifestyles and obesity [Tuomilehto J et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2001]. The World Health Organization reports that the most significant modifiable risk factor for T2DM is being overweight or obese [World Heart Federation. \u003Ca href=\u0022http:\/\/www.world-heart-federation.org\u0022\u003Ehttp:\/\/www.world-heart-federation.org\u003C\/a\u003E].\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe 3-year Finnish Diabetes Prevention Study was one of the first controlled, randomized reports to show that T2DM is preventable with lifestyle intervention [Tuomilehto J et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2001]. The study randomized 522 middle-aged, overweight subjects with impaired glucose tolerance to either a usual care control group or an intensive lifestyle intervention group. The control group received general dietary and exercise advice at baseline and an annual physician\u0027s examination. The subjects in the intervention group received additional individualized dietary counseling from a nutritionist. They were also offered circuit-type resistance training sessions and advised to increase their overall physical activity.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ESeveral beneficial changes in clinical and metabolic parameters were observed in the intervention group compared with the control group. Mean weight reduction was 4.2\u00b15.1 kg at Year 1 and 3.5\u00b15.5 kg at Year 3 (p\u0026lt;0.0001) compared with the control group. Significantly greater improvements were seen at Year 1 in fasting plasma glucose (\u22120.2 vs 0.0 mmol\/L), 2-hour plasma glucose (\u22120.9 vs \u22120.3 mmol\/L), and HbA1C (\u22120.1 vs 0.1%). During the first 3 years of the study, 22 (9%) in the intervention group and 51 (20%) in the control group developed diabetes (p=0.0001), translating into a 58% relative reduction in the risk of developing diabetes [Tuomilehto J et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2001].\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EMany other trials have shown that both lifestyle measures and pharmacological treatment can reduce the proportion of people with IGT who would otherwise develop diabetes [Waugh N et al. \u003Cem\u003EHealth Technol Assess\u003C\/em\u003E 2007]. In the Diabetes Prevention Program, lifestyle intervention reduced the incidence of diabetes by 58% (95% CI, 48% to 66%) and metformin reduced the incidence of diabetes by 31% (95% CI, 17% to 43%) compared with placebo in patients who were at risk and characterized by elevated fasting and postload plasma glucose concentrations [Knowler WC et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2002]. Using lifestyle interventions, the SLIM trial in the Netherlands showed a 58% decline in risk for diabetes; the EDIPS Newcastle \u2013 UK study, 55%; the Da Qing study in China, 43%; and the IDPP study in India, 28.5% (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/6\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Prevention of T2DM Through Lifestyle Management.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1652169267\u0022 data-figure-caption=\u0022Prevention of T2DM Through Lifestyle Management.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/6\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/6\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/6\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12462\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EPrevention of T2DM Through Lifestyle Management.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ESpringer Verlag. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Ramachandran A et al. \u003Cem\u003EDiabetologia;\u003C\/em\u003E 2006 Feb;49(2):289\u201397.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EProf. Tuomilehto noted that early intervention in hyperglycemia also has long-term, sustained effects after the end of the intervention. Linstrom et al. [Lindstrom J et al. \u003Cem\u003ELancet\u003C\/em\u003E 2006] found that beneficial lifestyle changes that were achieved by participants in the intervention group were maintained after the discontinuation of the intervention, and the corresponding incidence rates during the postintervention follow-up were 4.6 and 7.2 (p=0.0401), indicating a 36% reduction in relative risk. Similarly, there was no excess 12-year mortality in men with IGT who participated in diet and exercise in the Malm\u00f6 Preventive Trial [Eriksson KF, Lindgarde F. \u003Cem\u003EDiabetologia\u003C\/em\u003E 1998].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EScreening and Application\u003C\/h2\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EEarly detection of diabetes could lead to measures to reduce the risk of heart disease [Waugh N et al. \u003Cem\u003EHealth Technol Assess\u003C\/em\u003E 2007]. Detection of lesser degrees of glucose intolerance, such as IGT, is worthwhile, in part because the risk of CVD can be reduced with treatment that is aimed at lowering cholesterol levels and blood pressure and in part because some cases of diabetes could be prevented.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EThe Diabetes Risk Score was developed to identify individuals who are at risk for diabetes without laboratory tests. It was found to be a simple, fast, inexpensive, and reliable tool to identify individuals who are at high risk for diabetes [Lindstrom J, Tuomilehto J. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2003]. A more recent systematic review and economic modeling study on screening for T2DM found good cause for screening for IGT, with the aim of preventing future diabetes and reducing CVD [Waugh N et al. \u003Cem\u003EHealth Technol Assess\u003C\/em\u003E 2007].\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EThe Cardiovascular Health Study evaluated lifestyle risk factors and new-onset diabetes mellitus in older adults and demonstrated that even later in life, combinations of low-risk lifestyle factors are associated with a markedly lower incidence of new-onset diabetes mellitus [Mozaffarian D et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2009]. Last year, a systematic review of lifestyle modification and glucose intolerance in the prevention of T2DM found that intensive use of nonpharmacological lifestyle interventions, including manipulation of dietary intake and physical activity level, halved the risk of incident diabetes [Thomas GN et al. \u003Cem\u003ECurr Diabetes Rev\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EThe authors concluded that lifestyle modification is a useful weapon in the arsenal for preventing the onset of diabetes. Prof. Tuomilehto agrees: \u201cThe prevention of cardiovascular disease in diabetes starts with the prevention of diabetes,\u201d he concluded.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/10\/6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmyje\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmyje\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}