• Triad of modalities in preventing type 2 diabetes – Diet, exercise and medication.
• Lifestyle intervention can prevent type 2 diabetes onset. Several randomized trials have shown that interventions – lifestyle, medications – can decrease the rate of onset of diabetes. These include Da Qing Study, Finnish Diabetes Prevention Study and Diabetes Prevention Program for lifestyle interventions; and Diabetes Prevention Program (metformin), The Stop-NIDDM and ACT NOW (pioglitazone) for medications.
• ACT NOW - Pioglitazone reduced the risk of type 2 diabetes mellitus by 72% vs. placebo. Pioglitazone reduced fasting glucose, 2-hour glucose and HbA_1c.
• ADA 2019 nutritional recommendations – The eating patterns that may be helpful for those with prediabetes include a Mediterranean eating plan and a low-calorie, low-fat eating plan. Higher intakes of nuts, berries, yogurt, coffee and tea are associated with reduced diabetes risk.
• ADA 2019 pharmacological recommendations – Metformin therapy for prevention of type 2 diabetes should be considered in those with prediabetes, especially for those with BMI ≥35 kg/m², those aged <60 years and women with prior gestational diabetes mellitus. Metformin has the strongest evidence base and demonstrated long-term safety as pharmacologic therapy for diabetes prevention.

We must identify patients at high risk (prediabetes). Modest lifestyle changes are most effective. Increase opportunities for community programs to support prevention. Delaying or preventing type 2 diabetes is cost-effective and will help turn the tide on the diabetes epidemic.