Targeting people with pre-diabetes

Three major randomised controlled trials, conducted in diverse countries, settings, and populations, confirm that effective lifestyle intervention can prevent or delay the progression to type 2 diabetes in groups at high risk, such as overweight people with impaired glucose tolerance (glucose concentration 7.8-11.1 mmol/l, two hours after a 75 g loading).1–3 In the largest of these trials, the diabetes prevention programme in the United States, a lifestyle modification programme was delivered with the goals of at least a 7% weight loss and at least 150 minutes of physical activity per week.4 At 24 weeks, 50% of the participants in the lifestyle intervention group had achieved the weight loss goal and 74% had achieved the activity goal. In this trial, lifestyle intervention reduced the incidence of diabetes by 58%, and one case of diabetes was prevented for every 6.9 people treated for three years.3 In response to this impressive evidence, the American Diabetes Association's position statement on prevention of diabetes has recommended screening to detect people with impaired glucose tolerance or impaired fasting glucose (fasting …