Prevention of diabetes mellitus type 2

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Prevention of diabetes mellitus type 2 can be achieved with both lifestyle changes and use of medication.[1] The American Diabetes Association categorizes prediabetes as a high-risk group that has glycemic levels higher than normal but does not meet criteria for diabetes. Without intervention people with prediabetes progress to type 2 diabetes with a 5% to 10% rate. Diabetes prevention is achieved through weight loss and increased physical activity, which can reduce the risk of diabetes by 50% to 60%.[2]


Many interventions to promote healthy lifestyles have been shown to prevent diabetes. A combination of diet and physical activity promotion through counselling and support programs decrease weight, improve systolic blood pressure, improve cholesterol levels and decrease risk of diabetes.[2]

Increasing physical activity may be helpful in preventing type 2 diabetes, particularly if undertaken soon after a carbohydrate rich meal that increases blood sugar levels.[3][4][5] The American Diabetes Association (ADA) recommends maintaining a healthy weight, getting at least 2½ hours of exercise per week (several brisk sustained walks appear sufficient), having a modest fat intake (around 30% of energy supply should come from fat), and eating sufficient fiber (e.g., from whole grains).

Some preliminary evidence suggests that resistant starch, used as a substitute for refined carbohydrate, may increase insulin sensitivity[6] and may reduce the risk of type 2 diabetes.[7] The U.S. Food and Drug Administration requires claims that resistant starch can reduce the risk of type 2 diabetes to be qualified with a declaration that scientific evidence in support of this claim is limited.[8]

Foods with low glycemic index rich in fiber and other important nutrients are recommended notwithstanding insufficient evidence.[9][10]

Study group participants whose "physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes".[11]

Various sources suggest an influence of dietary fat types. Positive effects of unsaturated fats have been asserted on theoretical grounds and observed in animal feeding studies. Hydrogenated fats are universally considered harmful mainly because of well known effect on cardiovascular risk factors.[12]

There are numerous studies which suggest connections between some aspects of type 2 diabetes with ingestion of certain foods or with some drugs. Breastfeeding may also be associated with the prevention of type 2 diabetes in mothers.[13]

There is evidence relating consumption of coffee with prevention of type 2 diabetes. However, it is unclear if coffee causes any change in the risk of diabetes. This is true regardless of if it is caffeinated/decaffeinated; with/without sugar, or potboiled or not.[14]


Some studies have shown delayed progression to diabetes in predisposed patients through prophylactic use of metformin,[4] rosiglitazone,[15] or valsartan.[16]

Lifestyle interventions are, however, more effective than metformin at preventing diabetes regardless of weight loss.[17]

Many other medications are well known to modify risk of diabetes 2 although in most cases they are prescribed for reasons unrelated to diabetes 2. In patients on hydroxychloroquine for rheumatoid arthritis, incidence of diabetes was reduced by 77% though causal mechanisms are unclear.[18] Dopamine receptor agonists are also known to improve glycemic control, reduce insulin resistance and help controlling body weight.


  1. ^ Li G (December 2008). "Lifestyle interventions reduced the long-term risk of diabetes in adults with impaired glucose tolerance"Paid subscription required. Evidence-Based Medicine. 13 (6): 173. PMID 19043031. doi:10.1136/ebm.13.6.173. 
  2. ^ a b Balk, Ethan M.; Earley, Amy; Raman, Gowri; Avendano, Esther A.; Pittas, Anastassios G.; Remington, Patrick L. (15 September 2015). "Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force". Annals of Internal Medicine. 163 (6): 437–451. ISSN 1539-3704. PMC 4692590Freely accessible. PMID 26167912. doi:10.7326/M15-0452Freely accessible. 
  3. ^ Lindström J, Ilanne-Parikka P, Peltonen M, et al. (11 November 2006). "Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study". The Lancet. 368 (9548): 1673–9. PMID 17098085. doi:10.1016/S0140-6736(06)69701-8. (Subscription required (help)). 
  4. ^ a b Knowler WC, Barrett-Connor E, Fowler SE, et al. (7 February 2002). "Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin". The New England Journal of Medicine. 346 (6): 393–403. PMC 1370926Freely accessible. PMID 11832527. doi:10.1056/NEJMoa012512. 
  5. ^ Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM (14 November 2009). "10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study". Lancet. 374 (9702): 1677–1686. PMC 3135022Freely accessible. PMID 19878986. doi:10.1016/S0140-6736(09)61457-4. 
  6. ^ Bindels, Laurie; Walter, Jens; Ramer-Tait, Amanda (November 2015). "Resistant starches for the management of metabolic diseases"Paid subscription required. Curr Opin Clin Nutr Metab Care. 18: 559–65. PMC 4612508Freely accessible. PMID 26406392. doi:10.1097/mco.0000000000000223. 
  7. ^ Maki KC, Phillips AK (January 2015). "Dietary substitutions for refined carbohydrate that show promise for reducing risk of type 2 diabetes in men and women". J. Nutr. 145 (1): 159S–163S. PMID 25527674. doi:10.3945/jn.114.195149Freely accessible. 
  8. ^ Balentine, Douglas (13 December 2016). "Letter announcing decision for a health claim for high-amylose maize starch (containing type-2 resistant starch) and reduced risk of type 2 diabetes mellitus (Docket Number FDA-2015-Q-2352)". U.S. Food and Drug Administration. Retrieved 2016-12-16. 
  9. ^ American Diabetes Association, Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, Hoogwerf BJ, Lichtenstein AH, Mayer-Davis E, Mooradian AD, Wheeler ML (January 2008). "Nutrition Recommendations and Interventions for Diabetes: A position statement of the American Diabetes Association". Diabetes Care. 31: S61–S78. PMID 18165339. doi:10.2337/dc08-S061Freely accessible. 
  10. ^ Bantle JP, Wylie-Rosett J, Albright AL, et al. (September 2006). "Nutrition recommendations and interventions for diabetes—2006: a position statement of the American Diabetes Association". Diabetes Care. 29 (9): 2140–57. PMID 16936169. doi:10.2337/dc06-9914Freely accessible. 
  11. ^ Mozaffarian D, Kamineni A, Carnethon M, Djoussé L, Mukamal KJ, Siscovic D (April 2009). "Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study". Archives of Internal Medicine. 169 (8): 798–807. PMC 2828342Freely accessible. PMID 19398692. doi:10.1001/archinternmed.2009.21. 
  12. ^ Risérus U, Willett WC, Hu FB (January 2009). "Dietary fats and prevention of type 2 diabetes". Progress in Lipid Research. 48 (1): 44–51. PMC 2654180Freely accessible. PMID 19032965. doi:10.1016/j.plipres.2008.10.002. 
  13. ^ Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB (23 November 2005). "Duration of lactation and incidence of type 2 diabetes". JAMA. 294 (20): 2601–10. PMID 16304074. doi:10.1001/jama.294.20.2601Freely accessible. 
  14. ^ Muley, A; Muley, P; Shah, M (May 2012). "Coffee to reduce risk of type 2 diabetes?: a systematic review.". Current diabetes reviews. 8 (3): 162–8. PMID 22497654. doi:10.2174/157339912800564016. (Subscription required (help)). 
  15. ^ Gerstein HC, Yusuf S, Bosch J, et al. (23 September 2006). "Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial". Lancet. 368 (9541): 1096–105. PMID 16997664. doi:10.1016/S0140-6736(06)69420-8Freely accessible. 
  16. ^ Kjeldsen SE, Julius S, Mancia G, et al. (July 2006). "Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: the VALUE trial". Journal of Hypertension. 24 (7): 1405–12. PMID 16794491. doi:10.1097/01.hjh.0000234122.55895.5b. (Subscription required (help)). 
  17. ^ Knowler WC, Fowler SE, Hamman RF, et al. (14 November 2009). "10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study". Lancet. 374 (9702): 1677–86. PMC 3135022Freely accessible. PMID 19878986. doi:10.1016/S0140-6736(09)61457-4. 
  18. ^ Wasko MC, Hubert HB, Lingala VB, et al. (11 July 2007). "Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis". JAMA. 298 (2): 187–93. PMID 17622600. doi:10.1001/jama.298.2.187Freely accessible.