5MinuteConsult Journal Club
YES: You Can Reverse Type 2 Diabetes
Am J Prev Med 2022 Feb 9;S0749-3797(21)00596-1
Diabetes can be prevented if patients and providers collaborate on making lifestyle changes and judicious use of medication.
This systematic review of 54 studies evaluated the effects of lifestyle modification medications, dietary supplements, and traditional Chinese medicine to prevent prediabetes from evolving into type 2 diabetes. At a median follow-up of 1.6 years, more participants in the lifestyle modification groups achieved normoglycemia than those in the control (risk difference=0.18, number needed to treat=6) based upon strong evidence. Over a median follow-up of 2.7 years, participants receiving glucagon-like peptide-1 receptor agonists (risk difference=0.47, number needed to treat=2), α-glucosidase inhibitors (risk difference=0.29, number needed to treat=4), and insulin sensitizers (risk difference=0.23, number needed to treat=4) successfully achieved normoglycemia than control. The strength of evidence was moderate for these medications. Other studied interventions were not beneficial.
For those with prediabetes, aggressive implementation of small lifestyle changes, like eating fewer simple carbohydrates, getting both aerobic and resistance exercise, and mindful eating, alone or in combination with some medications, GLP-1 agonists, can prevent type 2 diabetes.
Prediabetes does not need to progress to diabetes; this study gives us NNT=2-6 for success. It takes commitment on both the patient and the provider’s side. Yes, you can succeed, as can your patients. Ask them how important it is to prevent them developing diabetes, and if it is, offer options to help them succeed.
More from 5MinuteConsult
Algorithms & Charts: Type 2 Diabetes, Treatment
Contributed by Frank J. Domino, March 2, 2022