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For guidelines related to screening for increased risk for type 2 diabetes (prediabe-
tes), please refer to Section 2, “Classification and Diagnosis of Diabetes” (https://
doi.org/10.2337/dc22-S002). For guidelines related to screening, diagnosis, and
management of type 2 diabetes in youth, please refer to Section 14, “Children and
Adolescents” (https://doi.org/10.2337/dc22-S014).
Recommendation
3.1 Monitor for the development of type 2 diabetes in those with prediabe-
tes at least annually, modified based on individual risk/benefit assess-
ment. E
Section 2, “Classification and Diagnosis vention in the U.S. comes from the DPP week similar in intensity to brisk walk-
of Diabetes” (https://doi.org/10.2337/ trial (1). The DPP demonstrated that ing. Participants were encouraged to
dc22-S002), and Section 6, “Glycemic intensive lifestyle intervention could distribute their activity throughout the
Targets” (https://doi.org/10.2337/dc22- reduce the risk of incident type 2 diabe- week with a minimum frequency of
S006), for additional details on the tes by 58% over 3 years. Follow-up of three times per week and at least 10
appropriate use and limitations of A1C three large studies of lifestyle interven- min per session. A maximum of 75 min
testing. tion for diabetes prevention has shown of strength training could be applied
sustained reduction in the risk of pro- toward the total 150 min/week physical
LIFESTYLE BEHAVIOR CHANGE gression to type 2 diabetes: 39% reduc- activity goal (8).
FOR DIABETES PREVENTION tion at 30 years in the Da Qing study To implement the weight loss and
(5), 43% reduction at 7 years in the physical activity goals, the DPP used an
Recommendations Finnish DPS (2), and 34% reduction at individual model of treatment rather
3.2 Refer adults with overweight/ 10 years (6) and 27% reduction at 15 than a group-based approach. This choice
Dietary Approaches to Stop Hypertension care settings has demonstrated the and modalities of behavioral counseling
(DASH) eating patterns are associated potential to reduce overall program costs for diabetes prevention may also be
with a lower risk of developing type 2 while still producing weight loss and dia- appropriate and efficacious based on
diabetes (16–19). Evidence suggests that betes risk reduction (36–40). patient preferences and availability. The
the overall quality of food consumed (as The Centers for Disease Control and use of community health workers to
measured by the Healthy Eating Index, Prevention (CDC) developed the National support DPP efforts has been shown to
Alternative Healthy Eating Index, and Diabetes Prevention Program (National be effective and cost-effective (44,45) (see
DASH score), with an emphasis on whole DPP), a resource designed to bring such Section 1, “Improving Care and Promot-
grains, legumes, nuts, fruits, and vegeta- evidence-based lifestyle change programs ing Health in Populations,” https://doi
bles and minimal refined and processed for preventing type 2 diabetes to commu- .org/10.2337/dc22-S001, for more infor-
foods, is also associated with a lower risk nities (www.cdc.gov/diabetes/prevention/ mation). The use of community health
of type 2 diabetes (18,20–22). As is the index.htm). This online resource includes workers may facilitate adoption of behav-
case for those with diabetes, individual- locations of CDC-recognized diabetes pre- ior changes for diabetes prevention while
include interaction with a coach, and the Vitamin D and Type 2 Diabetes (D2d) periodic monitoring of vitamin B12 lev-
attain the DPP outcomes of participation, prospective randomized controlled trial els in those taking metformin chroni-
physical activity reporting, and weight showed no significant benefit of vitamin cally to check for possible deficiency
loss. Therefore, providers should con- D versus placebo on the progression to (84,85) (see Section 9, “Pharmacologic
sider referring patients with prediabetes type 2 diabetes in individuals at high risk Approaches to Glycemic Treatment,”
to certified technology-assisted DPP pro- (75), post hoc analyses and meta-analy- https://doi.org/10.2337/dc22-S009, for
grams based on patient preference. ses suggest a potential benefit in specific more details).
populations (75–78). Further research is
PHARMACOLOGIC needed to define patient characteristics PREVENTION OF VASCULAR
INTERVENTIONS and clinical indicators where vitamin D DISEASE AND MORTALITY
supplementation may be of benefit (61).
Recommendations No pharmacologic agent has been Recommendation
3.6 Metformin therapy for preven- approved by the U.S. Food and Drug 3.8 Prediabetes is associated with
be based on their level of cardiovascular weight loss (9,98). In the DPP/DPPOS, 8. Diabetes Prevention Program (DPP) Research
risk, and increased vigilance is warranted progression to diabetes, duration of dia- Group. The Diabetes Prevention Program (DPP):
description of lifestyle intervention. Diabetes
to identify and treat these and other car- betes, and mean level of glycemia were Care 2002;25:2165–2171
diovascular risk factors (95). important determinants of development 9. Hamman RF, Wing RR, Edelstein SL, et al.
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PATIENT-CENTERED CARE GOALS thermore, ability to achieve normal glu- risk of diabetes. Diabetes Care 2006;29:
2102–2107
cose regulation, even once, during the
10. Evert AB, Dennison M, Gardner CD, et al.
Recommendation DPP was associated with a lower risk of Nutrition therapy for adults with diabetes or
3.9 In adults with overweight/obe- diabetes and lower risk of microvascular prediabetes: a consensus report. Diabetes Care
sity at high risk of type 2 diabe- complications (99). Observational follow 2019;42:731–754
tes, care goals should include up of the Da Qing study also showed 11. U.S. Department of Agriculture and U.S.
weight loss or prevention of Department of Health and Human Services.
that regression from impaired glucose Dietary Guidelines for Americans, 2020–2025.
weight gain, minimizing progres- tolerance to normal glucose tolerance
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