Precision prevention strategies are needed for people with pre-diabetes who do not respond to standard lifestyle programs.
Lifestyle Programs for Pre-Diabetes Fail to Meet Needs of Many at High Risk of Type 2 Diabetes
A new study conducted by a consortium of researchers from the U.S., U.K., and India, in collaboration with the Baker Heart and Diabetes Institute, reveals that a significant proportion of individuals with pre-diabetes are unlikely to benefit from standard lifestyle programs used globally to prevent type 2 diabetes. The findings, published in Diabetes Care by Dr. Sathish Thirunavukkarasu, highlight the need for precision prevention strategies that go beyond behavioral counseling to address the specific needs of this population. With two million Australians currently living with pre-diabetes and at high risk of developing type 2 diabetes, these results call for urgent action to identify effective interventions for this vulnerable group.
Studies conducted two decades ago demonstrated that lifestyle interventions could reduce the progression to diabetes among individuals with impaired glucose tolerance, a specific form of pre-diabetes. As a result, it has become standard practice worldwide to implement these lifestyle programs in all individuals with pre-diabetes, regardless of their specific type of pre-diabetes. However, the recent research aimed to investigate whether conventional lifestyle interventions have the same effect on diabetes incidence in different types of pre-diabetes.
The study analyzed data from randomized controlled trials conducted globally and confirmed that individuals with impaired glucose tolerance, with or without impaired fasting glucose, experienced a significant reduction in diabetes incidence after participating in lifestyle interventions. However, no such effect was observed in individuals with isolated impaired fasting glucose, which constitutes a substantial proportion of the global pre-diabetes population. This suggests that the current approach may not be effective for a significant number of people with pre-diabetes.
Senior author Professor Jonathan Shaw, Head of Clinical Diabetes and Epidemiology at the Baker Institute, highlighted the prevalence of isolated impaired fasting glucose in different populations. Recent analysis of 14 studies involving over 27,000 individuals with pre-diabetes revealed that 58% of Caucasians and 48% of Asians had this specific type of pre-diabetes. Moreover, isolated impaired fasting glucose significantly increases the risk of developing diabetes four- to sixfold compared to individuals with normal blood sugar levels. It is also associated with a high risk of cardiovascular disease and even death.
Given the high prevalence and elevated risks associated with isolated impaired fasting glucose, Professor Shaw emphasized the urgent need for more research to identify effective interventions for this specific group of individuals at high risk of developing type 2 diabetes. Promising strategies that could be explored include low-calorie diets (1,200 kcal/day) and high-intensity interval training. By tailoring prevention efforts to the needs of these individuals, it may be possible to reduce the incidence of type 2 diabetes and its associated complications.
The current standard lifestyle programs used globally to prevent type 2 diabetes may not be effective for a significant proportion of individuals with pre-diabetes, particularly those with isolated impaired fasting glucose. Precision prevention strategies are urgently needed to address the specific needs of this vulnerable population. With millions of people at high risk of developing type 2 diabetes, further research is crucial to identify interventions that can effectively reduce the incidence of this chronic disease and improve the overall health outcomes for individuals with pre-diabetes.