In people with prediabetes, monitor for the development of type 2 diabetes at least annually; modify based on individual risk assessment.
Refer adults with overweight or obesity at high risk of DM2, as seen in the Diabetes Prevention Program (DPP), to an intensive lifestyle behavior change program to achieve and maintain a weight reduction of at least 7% of initial body weight through healthy reduced-calorie diet and ≥150 min/week of moderate-intensity physical activity.
A variety of healthy eating patterns can be considered to prevent DM2 in individuals with prediabetes.
Given the cost-effectiveness of lifestyle behavior modification programs for diabetes prevention, such diabetes prevention programs should be offered to adults at high risk of DM2.
Based on individual preference, certified technology-assisted diabetes prevention programs may be effective in preventing DM2 and should be considered.
Metformin for the prevention of DM2 should be considered in adults at high risk of DM2, as typified by the DPP, especially those aged 25–59 years with BMI ≥35 kg/m2, higher fasting plasma glucose (e.g., ≥110 mg/dL [≥6 mmol/L]), and higher HbA1C (e.g., ≥6.0%), and in individuals with prior gestational diabetes mellitus.
Prediabetes is associated with heightened cardiovascular risk; therefore, screening for and treatment of modifiable risk factors for cardiovascular disease are suggested.
Statin therapy may increase the risk of DM2 in people at high risk of developing DM2. In such individuals, glucose status should be monitored regularly and diabetes prevention approaches reinforced. It is not recommended that statins be discontinued for this adverse effect.
In people with a history of stroke and evidence of insulin resistance and prediabetes, pioglitazone may be considered to lower the risk of stroke or myocardial infarction. However, this benefit needs to be balanced with the increased risk of weight gain, edema, and fractures. Lower doses may mitigate the risk of adverse effects but may be less effective.
In adults with overweight or obesity at high risk of DM2, care goals should include weight loss and maintenance, minimizing the progression of hyperglycemia, and attention to cardiovascular risk.
Pharmacotherapy (e.g., for weight management, minimizing the progression of hyperglycemia, and cardiovascular risk reduction) may be considered to support person-centered care goals.
More intensive preventive approaches should be considered in individuals who are at particularly high risk of progression to diabetes, including individuals with BMI ≥35 kg/m2, those at higher glucose levels (e.g., fasting plasma glucose 110–125 mg/dL, 2–h postchallenge glucose 173–199 mg/dL, and HbA1C ≥6.0%, and individuals with a history of gestational diabetes mellitus.
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Resource Person: Dr. Suzan Gharaibeh