Diabetes Standards of Care and Resources for Clinicians and Educators

Lifestyle Interventions

The National Institutes of Health Diabetes Prevention Program (DPP) clinical trial found that an intensive lifestyle intervention (ILI) lowered diabetes incidence by 58% in individuals at high risk for diabetes.¹ The 16-session ILI program established a weight loss goal of 7% from baseline and a physical activity goal of 150 minutes per week. The reduction in diabetes incidence with the ILI was similar in all racial subgroups, including American Indian people.

The Special Diabetes Program for Indians Diabetes Prevention demonstration project showed that a Native Lifestyle Balance Curriculum (modified 16-session, 6-month DPP ILI curriculum) could be successfully implemented in American Indian/Alaska Native (AI/AN) communities.²

Resources on lifestyle intervention programs for diabetes prevention:

• The Diabetes Prevention Program Toolkit Exit Disclaimer: You Are Leaving www.ihs.gov  of the SDPI describes how to establish and implement a Diabetes Prevention Program (DPP).
• The Centers for Disease Control and Prevention (CDC) offers curricula and formal recognition of lifestyle change programs through the National DPP. Exit Disclaimer: You Are Leaving www.ihs.gov 
• The Medicare Diabetes Prevention Program Expanded Model Exit Disclaimer: You Are Leaving www.ihs.gov  offers reimbursement for Medicare beneficiaries participating in CDC-recognized diabetes prevention programs.

Metformin

Medications can prevent or delay the progression to diabetes. Metformin, an anti-hyperglycemic agent, reduced diabetes incidence by 31% in the National Institutes of Health DPP trial.¹ Metformin is most effective for diabetes prevention in adults with prediabetes and any of the following characteristics:

• Body mass index of at least 35 kg/m²
• Age less than 60 years
• History of gestational diabetes mellitus

Note: Metformin is U.S. Food and Drug Administration (FDA)-approved for hyperglycemia treatment in people with type 2 diabetes, but not for diabetes prevention.

Other Medications

Several other medications have been shown to prevent or delay diabetes in people with prediabetes. Weight loss drugs, such as orlistat and topiramate-phentermine, and anti-diabetes agents, including GLP-1 receptor agonists, dual GIP/GLP-1 receptor agonists, acarbose, and pioglitazone reduce the rate of diabetes development in people at-risk for diabetes. However, there are currently no FDA-approved medications for diabetes prevention. Providers should discuss the risks and benefits of these agents with patients before prescribing them for diabetes prevention.

References

1. Knowler W, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; DPP Research Group. A randomized clinical trial to prevent type 2 diabetes in persons at high risk. N Engl J Med 2002;346:393-403. DOI: 10.1056/NEJMoa012512
2. Jiang L, Manson SM, Beals J, Henderson WG, Huang H, Acton KJ, Roubideaux Y; Special Diabetes Program for Indians Diabetes Prevention Demonstration Project. Translating the Diabetes Prevention Program into American Indian and Alaska Native communities: Results from the Special Diabetes Program for Indians Diabetes Prevention demonstration project. Diabetes Care 2013;36:2027-2034. https://doi.org/10.2337/dc12-1250