The Indian Diabetes Prevention Program (IDPP): Both lifestyle modification and metformin significantly reduced the incidence of diabetes in Asian Indians with impaired glucose tolerance (IGT). There was no added benefit from combining them.

The Diabetes Community Lifestyle Improvement Program (D-CLIP) study revealed that a stepwise diabetes prevention program reduced the 3-year diabetes risk by 32% in overweight/obese Asian Indian adults with isolated impaired glucose tolerance (iIGT), isolated impaired fasting glucose (iIFG), or IFG + IGT. The Diabetes Prevention Program Outcomes Study revealed that lifestyle intervention or metformin significantly reduced diabetes development over 15 years. There were no overall differences in the aggregate microvascular outcome between treatment groups; however, those who did not develop diabetes had a lower prevalence of microvascular complications than those who developed diabetes.

The Diabetes Prevention Program (DPP) Study revealed that 30 minutes a day of moderate physical activity along with a 5-10% weight loss produced a 58% reduction in diabetes.

Recommendations for prevention or delay of T2DM – Patients with prediabetes should be referred to an intensive diet and physical activity behavioral counseling program adhering to the tenets of the DPP targeting a loss of 7% of body weight, and should increase their moderate physical activity to at least 150 min/week; Based on cost-effectiveness of diabetes prevention, such programs should be covered by third-party payers; Metformin therapy for prevention of type 2 diabetes should be considered in those with prediabetes, especially for those with BMI ≥35 kg/m2, aged <60 years, women with prior gestational diabetes (GDM), those with rising A1c despite lifestyle intervention.