The rationale, design, and baseline characteristics of PREVENT-DM: A community-based comparative effectiveness trial of lifestyle intervention and metformin among Latinas with prediabetes. Improvement in diet habits, independent of physical activity helps to reduce incident diabetes among prediabetic Asian Indian men. ForgIng New paths in DIabetes PrevenTion (FINDIT): Study Protocol for a Randomized Controlled Trial Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Development and Validation of a Patient Self-assessment Score for Diabetes Risk Development of a community participation program for diabetes mellitus prevention in a primary care unit, Thailand. Metformin is effective in achieving biochemical response in patients with nonalcoholic fatty liver disease (NAFLD) not responding to lifestyle interventions. Association between Metformin Use and Cancer Stage at Diagnosis among Elderly Medicare Beneficiaries with Preexisting Type 2 Diabetes Mellitus and Incident Prostate Cancer Screening for Type 2 Diabetes Mellitus in Adults: Recommendations and Rationale Translating the Diabetes Prevention Program to Primary Care: A Pilot Study Screening for Type 2 Diabetes in a High-Risk Population: Effects of a Negative Screening Test After 4 Years Follow-up Rationale and design of the ADDITION-Leicester study, a systematic screening programme and Randomised Controlled Trial of multi-factorial cardiovascular risk intervention in people with Type 2 Diabetes Mellitus detected by screening The Diabetes Prevention Program. Design and methods for a clinical trial in the prevention of type 2 diabetes. PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin. HbA1c as a Predictor of Diabetes and as an Outcome in the Diabetes Prevention Program: A Randomized Clinical Trial Lifestyle and Metformin Interventions Have a Durable Effect to Lower CRP and tPA Levels in the Diabetes Prevention Program Except in Those Who Develop Diabetes The comparative efficacy of lifestyle intervention and metformin by educational attainment in the Diabetes Prevention Program.
Promotora Effectiveness Versus Metformin Trial ( PREVENT-DM ) is a r and omized comparative effectiveness trial of a lifestyle intervention based on the Diabetes Prevention Program delivered by community health workers ( or promotoras ) , metformin , and st and ard care . Eligibility criteria are Hispanic ethnicity , female sex , age ≥ 20 years , fluent Spanish-speaking status , BMI ≥ 23 kg/m(2 ) , and prediabetes . We enrolled 92 participants and r and omized them to one of the following three groups : st and ard care , DPP-based lifestyle intervention , or metformin . The primary outcome of the trial is the 12-month difference in weight between groups . Secondary outcomes include the following cardiometabolic markers : BMI , waist circumference , blood pressure , and fasting plasma glucose , hemoglobin A1C ( HbA1c ) , total cholesterol , triglycerides , LDL cholesterol , HDL cholesterol , and insulin . PREVENT-DM participants are socioeconomically disadvantaged Latinas with a mean annual household income of $ 15,527 ± 9922 and educational attainment of 9.7 ± 3.6 years . Eighty-six percent of participants are foreign born , 20 % have a prior history of gestational diabetes , and 71 % have a first-degree relative with diagnosed diabetes . At baseline , PREVENT-DM participants had a mean age of 45.1 ± 12.5 years , weight of 178.8 ± 39.3 lbs , BMI of 33.3 ± 6.5 kg/m(2 ) , HbA1c of 5.9 ± 0.2 % , and waist circumference of 97.4 ± 11.1 cm . Mean baseline levels of other cardiometabolic markers were normal . The PREVENT-DM study successfully recruited and r and omized an understudied population of Latinas with prediabetes . This trial will be the first U.S. study to test the comparative effectiveness of metformin and lifestyle intervention versus st and ard care among prediabetic adults in a " real-world " setting AIMS To assess the beneficial effects of the components of lifestyle intervention in reducing incidence of diabetes in Asian Indian men with impaired glucose tolerance ( IGT ) in India . METHODS This analysis was based on a 2 year prospect i ve , r and omized controlled primary prevention trial in a cohort of Asian Indian men with IGT ( n=537 ) ( Clinical Trial No : NCT00819455 ) . Intervention and control groups were given st and ard care advice at baseline . Additionally , the intervention group received frequent , mobile phone based text message reminders on healthy lifestyle principles .  Dietary intake and physical activity habits were recorded by vali date d question naires . The lifestyle goals were : reductions in consumption of carbohydrates , oil , portion size and body mass index of at least 1 unit ( 1 kg/m(2 ) ) from baseline and maintenance of good physical activity . The association between diabetes and lifestyle goals achieved was assessed using multiple logistic regression analyses . Changes in insulin sensitivity ( Matsuda 's insulin sensitivity index ) and oral disposition index during the follow-up were assessed . RESULTS At the end of the study , 123 ( 23.8 % ) participants developed diabetes  . The mean lifestyle score was higher in the intervention group compared with control ( 2.59 ± 1.13 vs. 2.28 ± 1.17 ; P=0.002 ) . Among the 5 lifestyle variables , significant improvements in the 3 dietary goal were seen with intervention . Concomitant improvement in insulin sensitivity and oral disposition index was noted . Higher lifestyle score was associated with lower risk of developing diabetes ( odds ratio : 0.54 [ 95 % CI : 0.44 - 0.70 ] ; P<0.0001 ) . CONCLUSIONS Beneficial effects of intervention were associated with increased compliance to lifestyle goals . The plausible mechanism is through improvement in insulin sensitivity and beta cell preservation Background Prediabetes is an asymptomatic condition in which patients ’ blood glucose levels are higher than normal but do not meet diagnostic criteria for type 2 diabetes mellitus ( T2DM ) . A key window of opportunity to increase engagement of patients with prediabetes in strategies to prevent T2DM is when they are screened for T2DM and found to have prediabetes , yet the effects of this screening and brief counseling are unknown . Methods In this parallel- design r and omized controlled trial we will recruit 315 non-diabetic patients from the Ann Arbor VA Medical Center ( AAVA ) who have one or major risk factors for T2DM and an upcoming primary care appointment at the AAVA , but have not had a hemoglobin A1c ( HbA1c ) test to screen for T2DM in the previous 12 months . After informed consent , participants will complete a baseline survey and be r and omly assigned to , at the time of their next primary care appointment , one of two arms : ( 1 ) to have a hemoglobin A1c ( HbA1c ) test to screen for T2DM and receive brief , st and ardized counseling about these results or ( 2 ) to review a brochure about clinical preventive services . Participants will complete surveys 2 weeks , 3 months , and 12 months after their primary care appointment , and a weight measurement 12 months after their primary care appointment . The primary outcome is weight change after 12 months . The secondary outcomes are changes in perception of risk for T2DM ; knowledge of T2DM prevention ; self-efficacy and motivation to prevent T2DM ; use of pharmacotherapy for T2DM prevention ; physical activity ; participation in weight management programs ; and mental health . Quantitative analyses will compare outcomes among participants in the HbA1c test arm found to have prediabetes with participants in the brochure arm . Among participants in the HbA1c test arm found to have prediabetes we will conduct semi-structured interviews about their underst and ing of and reactions to receiving a prediabetes diagnosis . Discussion This trial will generate foundational data on the effects of a prediabetes diagnosis and brief counseling on patients ’ preventive behaviors and mediators of these behaviors that will enable the development of novel strategies to improve patient engagement in T2DM prevention . Trial registration Clinical Trials.gov , NCT02747108 . Registered on 18 April 2016 OBJECTIVE The Diabetes Prevention Program ( DPP ) demonstrated that intensive lifestyle and metformin interventions reduced the incidence of type 2 diabetes compared with a placebo intervention . The aim of this study was to assess the cost-effectiveness of the lifestyle and metformin interventions relative to the placebo intervention . RESEARCH DESIGN AND METHODS Analyses were performed from a health system perspective that considered direct medical costs only and a societal perspective that considered direct medical costs , direct nonmedical costs , and indirect costs . Analyses were performed with the interventions as implemented in the DPP and as they might be implemented in clinical practice . RESULTS The lifestyle and metformin interventions required more re sources than the placebo intervention from a health system perspective , and over 3 years they cost approximately US dollars 2250 more per participant . As implemented in the DPP and from a societal perspective , the lifestyle and metformin interventions cost US dollars 24400 and US dollars 34500 , respectively , per case of diabetes delayed or prevented and US dollars 51600 and US dollars 99200 per quality -adjusted life-year ( QALY ) gained . As the interventions might be implemented in routine clinical practice and from a societal perspective , the lifestyle and metformin interventions cost US dollars 13200 and US dollars 14300 , respectively , per case of diabetes delayed or prevented and US dollars 27100 and US dollars 35000 per QALY gained . From a health system perspective , costs per case of diabetes delayed or prevented and costs per QALY gained tended to be lower . CONCLUSIONS Over 3 years , the lifestyle and metformin interventions were effective and were cost-effective from the perspective of a health system and society . Both interventions are likely to be affordable in routine clinical practice , especially if implemented in a group format and with generic medication pricing Context Guidelines disagree about who should receive screening for diabetes . Screening all adults would be expensive and lead to many false-positive results . Contribution The authors created a tool that allows people to estimate their own diabetes risk with questions they can easily answer ( age , sex , family history of diabetes , personal history of high blood pressure , obesity , and physical activity ) . This tool performs better than other available methods . Implication People can use this tool to help decide whether their risk for diabetes is high enough to warrant seeing a doctor to have blood glucose measured . The Editors Diabetes and its complications are major causes of morbidity and mortality worldwide . More than 60 million U.S. adults are estimated to have diagnosed diabetes , undiagnosed diabetes , or prediabetes , and approximately 30 % of diabetes cases are estimated to be undiagnosed . With the steadily increasing prevalence of diabetes , prevention of diabetes has become a major health priority ( 15 ) . Recent clinical trials demonstrate that lifestyle ( 68 ) and pharmaceutical ( 6 , 9 , 10 ) interventions in persons with impaired glucose tolerance can prevent or delay diabetes , providing a rationale for the identification of high-risk persons who may benefit from early lifestyle interventions . National guidelines for diabetes screening are available to help detect undiagnosed disease , and various risk assessment tools for prevalent or incident diabetes have been developed to identify persons most in need of screening . Yet , many of these risk assessment tools were developed from specific cohorts , which often have restricted age ranges or racial or ethnic groups , limiting generalizability to the entire population . In the United States , 3 national guidelines for diabetes screening are those of the Centers for Disease Control and Prevention ( 11 ) , the American Diabetes Association ( ADA ) ( 12 ) , and the U.S. Preventive Services Task Force ( 13 ) . In addition , 2 risk-scoring algorithms for undiagnosed diabetes have been derived from nationally representative sample s : Herman and colleagues ' ( 14 ) model from the NHANES ( National Health and Nutrition Examination Survey ) II ( conducted from 1976 to 1980 ) and Heikes and colleagues ' ( 4 ) model from the NHANES III ( conducted from 1988 to 1994 ) . These 2 algorithms are also known as the ADA diabetes question naires . We developed a new screening score for undiagnosed diabetes in multiethnic U.S. adults by using readily available health information . Our aim was to improve existing algorithms for diabetes-risk scoring by using a more contemporary NHANES ( 1999 to 2006 ) and formulating an easy scoring system that enables laypersons to assess their own risk for undiagnosed diabetes . Methods Study Design and Participants The NHANES is a cross-sectional study conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention . To represent the U.S. population , NHANES used complex , multistage probability sampling of the civilian , noninstitutionalized population . To produce reliable statistics , NHANES over sample d elderly persons and some racial and ethnic minorities . We used deidentified data from multiple years of NHANES ( 1999 to 2006 ) that are publicly available . We included participants aged 20 years or older who had fasting plasma glucose ( FPG ) results . We excluded pregnant women . We used NHANES 1999 to 2004 for prediction modeling and screening score development and NHANES 2005 to 2006 for validation . We conducted further validation by combining the baseline data from 2 biracial cohort studies : the ARIC ( Atherosclerosis Risk in Communities ) Study ( 15 ) and the CHS ( Cardiovascular Health Study ) ( 16 ) . Detailed descriptions of these studies are published elsewhere ( 15 , 16 ) . In brief , ARIC enrolled 15732 participants aged 45 to 64 years between 1987 and 1989 from 4 communities , and CHS recruited 5201 participants aged 65 years or older between 1989 and 1990 from 4 communities . Between 1992 and 1993 , CHS enrolled an additional 687 black persons to increase minority participation . Participant Data For each participant , we retrieved data that were collected through interviews , physical examinations , and laboratory tests . Specifically , we used data on participants ' demographic and socioeconomic characteristics , health care use , personal and family medical histories , health habits , physical examinations ( including anthropometric findings ) , and laboratory test results . For the obesity measure , we combined body mass index and waist circumference . For variable categorization , we used conventional cutoffs or well-accepted clinical guidelines when available . If information was missing or unknown in categorical variables , we defined the condition as absent , a convention commonly adopted in the risk- question naire setting . In our question naire , we instructed users , Enter your score ( but if you do n't know the answer , enter 0 ) . We stratified the participants into 4 groups by diabetes status : known diabetes , normal glucose metabolism ( FPG level < 5.5 mmol/L [ < 100 mg/dL ] ) , impaired fasting glucose or prediabetes ( FPG level of 5.6 to 6.9 mmol/L [ 100 to 125 mg/dL ] ) , and undiagnosed diabetes ( FPG level 7.0 mmol/L [ 126 mg/dL ] ) ( 4 , 17 , 18 ) . Specifically , we classified participants as having known diabetes if they answered yes to the question , Other than during pregnancy , have you ever been told by a doctor or health professional that you have diabetes or sugar diabetes ? or reported use of insulin or other diabetes medications . For medical history variables , we considered data from multiple sources . For example , we classified participants as having hypertension if they reported a history of hypertension , reported using prescribed medication for hypertension , had a systolic blood pressure of 140 mm Hg or higher , or had a diastolic blood pressure of 90 mm Hg or higher . We defined hyperlipidemia as a total cholesterol level of 5.17 mmol/L ( 200 mg/dL ) or greater or a triglyceride level of 1.69 mmol/L ( 150 mg/dL ) or greater ( 19 ) , and high cholesterol level as history of high cholesterol , use of cholesterol-lowering medication , or a fasting low-density lipoprotein cholesterol level of 2.59 mmol/L ( 100 mg/dL ) or greater with a history of cardiovascular disease ( 20 ) . We defined cardiovascular disease as myocardial infa rct ion or stroke . When definitions of variables were not identical across the different studies ( for example , physical activity ) , we tried to use the best available variables to achieve reasonable consistency across data bases . For example , in NHANES , we classified participants as physically active if they answered more active to the question , Compare your activity with others of the same age . Otherwise , we classified participants as not physically active . In ARIC , physical activity was assessed in a question with a response of yes or no , whereas in CHS , we dichotomized the physical activity question into no or low versus moderate or high . None of the data bases we used collected data during pregnancy . Finally , some ARIC participants ( n= 521 ) did not fast . For these persons , we used a r and om blood glucose level of 11.1 mmol/L ( 200 mg/dL ) as the cut-point to define diabetes ( 12 , 18 , 21 ) . We did not include nonfasting participants in the model development ( using NHANES ) but did include them in the external validation to reflect a realistic scenario . Statistical Analysis We used descriptive statistics to characterize the 4 groups according to diabetes status : we used means ( SEs ) for continuous variables and percentages for categorical variables . For model fitting , we used multiple logistic regression with cases of undiagnosed diabetes as the end point , excluding cases of diagnosed diabetes . Because of small proportions of missing data , we used all nonmissing observations available in the relevant analyses . The only exception is that we imputed family history of diabetes by using a statistical technique ( missing data imputation procedure , Proc MI , in SAS , SAS Institute , Cary , North Carolina ) to h and le missing data in CHS because this information was not collected in CHS ( 22 , 23 ) . Development of a New Screening Score Using the development data set ( NHANES 1999 to 2004 ) , we included a comprehensive list of predictors known to be potentially associated with undiagnosed diabetes in an initial model . Specifically , we included the main effects of all variables listed in Appendix Table 1 and their interaction effects with age . Because the number of covariates was large , we started with continuous variables and later categorized them in the final model . We used backward elimination ( deleting the covariate with the largest P value , 1 at a time ) from the initial model until we reached a final model with statistically significant covariates . We were guided by statistical significance for the model building but also used scientific and qualitative judgments as well . For example , although income and health insurance status were statistically significant , we did not keep these variables in the final model because we deemed them less appropriate or less user-friendly in risk assessment question naires . Physical activity showed borderline significance ( P= 0.064 ) in the development data set but was kept because this is an underlying protective factor that often does not reach statistical significance for various reasons ( for example , difficult to quantify , misclassification , or insufficient statistical power ) . Moreover , physical activity is highly modifiable compared with demographic and health history variables ( 24 ) . Appendix Table 1 . Characteristics of Participants in NHANES 1999 to 2004 , by Diabetes Status In the final model , we double-checked that any important covariates were not erroneously omitted in this sequential process . We intentionally used only categorized variables that captured easy but relevant and vali date d health information in the prediction model , to develop a user-friendly and The purpose of this study was to create and test a prevention model for diabetes mellitus in a primary care unit in Thail and . This study used a three-stage approach : a situational analysis was conducted by a focus group discussion , a model was developed in a brainstorming session with stakeholders , and the model was tested by community participation . Qualitative and quantitative methods were used to collect and analyze the data . The focus group discussion found that co-operation between health volunteers and primary care unit personnel in relation to diabetes screening , as well as defining the role of nurse practitioners who provide diabetic treatment , was important . The proactive model that was used for preventing diabetes mellitus was a health promotion program . It was trialed with 160 persons with prediabetes for 3 months . After the intervention , the mean score for exercise activity  among the persons with prediabetes was significantly higher , while the mean score of the Body Mass Index , waist circumference , and systolic blood pressure were significantly lower than before the intervention . This meant that community participation provided proactive services to Thai persons with prediabetes BACKGROUND Insulin resistance plays an important role in the pathogenesis of NAFLD . Pharmacological treatment of patients with NAFLD is still evolving . Insulin sensitizing drugs like metformin may be effective in these patients . Twenty five adult patients with NAFLD who did not achieve normalization of alanine transaminases ( ALT ) after 6 months of lifestyle interventions and UDCA were treated with metformin 500 mg tid for 6 months . Insulin resistance was determined by HOMA- IR . Liver function tests were done monthly and patients were defined having no response , partial response or complete biochemical response depending on the change in ALT . Results were compared with 25 patients with NAFLD from the same cohort treated only with lifestyle interventions ( disease controls ) . RESULTS Thirteen ( 52 % ) patients had class III ( n = 5 ) or class IV ( n = 8) disease amounting to histological NASH . Of these 13 patients none had severe inflammation and none had stage 4 fibrosis ( cirrhosis ) . All 25 patients with NAFLD had insulin resistance in comparison to healthy controls . In comparison to disease controls ( 127.5 + /- 41.8 vs. 118 + /- 21.6 p = NS ) , all patients treated with metformin had partial biochemical response ( mean ALT 122.2 + /- 26.8 vs 74.3 + /- 4.2 p < 0.01 ) and 14 ( 56 % ) of them achieved complete normalization of ALT . CONCLUSIONS Metformin is effective to achieve biochemical response in patients with NAFLD who do not respond to lifestyle interventions  and UDCA Objective . To examine the association between metformin use and cancer stage at diagnosis among elderly men with preexisting diabetes mellitus and incident prostate cancer . Methods . This study used a population -based observational cohort of elderly men ( ≥66 years ) with preexisting diabetes and incident prostate cancer between 2008 and 2009 ( N = 2,652 ) . Cancer stage at diagnosis ( localized versus advanced ) was based on the American Joint Cancer Committee classification . Metformin use and other independent variables were measured during the one year before cancer diagnosis . Logistic regressions with inverse probability treatment weights were used to control for the observed selection bias . Results . A significantly lower percentage of metformin users were diagnosed with advanced prostate cancer as compared to nonusers ( 4.7 % versus 6.7 % , p < 0.03 ) . After adjusting for the observed selection bias and other independent variables , metformin use was associated with a 32 % reduction in the risk of advanced prostate cancer ( adjusted odds ratio , AOR : 0.68 , 95 % confidence interval , CI : 0.48 , 0.97 ) . Conclusions . This is the first epidemiological study to support the role of metformin in reducing the risk of advanced prostate cancer . R and omized clinical trials are needed to confirm the causal link between metformin use and prostate cancer diagnosis stage Summary of the Recommendations The U.S. Preventive Services Task Force ( USPSTF ) concludes that the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes , impaired glucose tolerance , or impaired fasting glucose . This is a grade I recommendation . ( See Appendix Table 1 for a description of the USPSTF classification of recommendations . ) The USPSTF found good evidence that available screening tests can accurately detect type 2 diabetes during an early , asymptomatic phase . ( See Appendix Table 2 for a description of the USPSTF classification of levels of evidence . ) The USPSTF also found good evidence that intensive glycemic control in patients with clinical ly detected ( not screening detected ) diabetes can reduce the progression of microvascular disease . However , the benefits of tight glycemic control on microvascular clinical outcomes take years to become apparent . It has not been demonstrated that beginning diabetes control early as a result of screening provides an incremental benefit compared with initiating treatment after clinical diagnosis . Existing studies have not shown that tight glycemic control significantly reduces macrovascular complications , including myocardial infa rct ion and stroke . The USPSTF found poor evidence to assess possible harms of screening . As a result , the USPSTF could not determine the balance of benefits and harms of routine screening for type 2 diabetes . The USPSTF recommends screening for type 2 diabetes in adults with hypertension or hyperlipidemia . This is a grade B recommendation . The USPSTF found good evidence that , in adults who have hypertension and clinical ly detected diabetes , lowering blood pressure below conventional target blood pressure values reduces the incidence of cardiovascular events and cardiovascular mortality ; this evidence is considered fair when extrapolated to cases of diabetes detected by screening . Among patients with hyperlipidemia , there is good evidence that detecting diabetes substantially improves estimates of individual risk for coronary heart disease , which is an integral part of decisions about lipid-lowering therapy . Clinical Considerations In the absence of evidence of direct benefits of routine screening for type 2 diabetes , the decision to screen individual patients is a matter of clinical judgment . Patients at increased risk for cardiovascular disease may benefit most from screening for type 2 diabetes , since management of cardiovascular risk factors leads to reductions in major cardiovascular events . Clinicians should assist patients in making that choice . In addition , clinicians should be alert to symptoms suggestive of diabetes ( for example , polydipsia and polyuria ) and test anyone with these symptoms . Screening for diabetes in patients with hypertension or hyperlipidemia should be part of an integrated approach to reduce cardiovascular risk . Lower targets for blood pressure ( that is , diastolic blood pressure 80 mm Hg ) are beneficial for patients with diabetes and high blood pressure . The third report of the Adult Treatment Panel III of the National Cholesterol Education Program recommends lower targets for low-density lipoprotein cholesterol for patients with diabetes . Attention to other risk factors , such as physical inactivity , diet , and overweight , is also important , both to decrease risk for heart disease and to improve glucose control . Three tests have been used to screen for diabetes : fasting plasma glucose ( FPG ) , 2-hour postload plasma glucose , and hemoglobin A1c .  The American Diabetes Association ( ADA ) has recommended the FPG test for screening ( values 6.99 mmol/L [ 126 mg/dL ] indicate diabetes ) because it is easier and faster to perform , more convenient and acceptable to patients , and less expensive than other screening tests . The FPG test is more reproducible than the 2-hour plasma glucose test , has less intraindividual variation , and has similar predictive value for development of microvascular complications of diabetes . Compared with the FPG test , the 2-hour plasma glucose test may lead to more individuals being diagnosed as diabetic . Hemoglobin A1c is more closely related to FPG than to 2-hour plasma glucose , but at the usual cut-points it is less sensitive in detecting lower levels of hyperglycemia . The r and om  capillary blood glucose test has been shown to have reasonable sensitivity ( 75 % at a cut-point of 6.66 mmol/L [ 120 mg/dL ] ) in detecting persons who have an FPG level greater than or equal to 6.99 mmol/L ( 126 mg/dL ) or a 2-hour plasma glucose level greater than or equal to 11.1 mmol/L ( 200 mg/dL ) , if results are interpreted according to age and time since last meal ; however , the r and om blood glucose test is less well st and ardized for screening for diabetes . The ADA recommends confirmation of a diagnosis of diabetes with a repeated FPG test on a separate day , especially for patients with borderline FPG results and patients with normal FPG levels for whom suspicion of diabetes is high . The optimal screening interval is not known . The ADA , on the basis of expert opinion , recommends an interval of every 3 years but shorter intervals in high-risk persons . Regardless of whether the clinician and patient decide to screen for diabetes , patients should be encouraged to exercise , eat a healthy diet , and maintain a healthy weight , choices that may prevent or forestall the development of type 2 diabetes . More aggressive interventions to establish and maintain these behaviors should be considered for patients at increased risk for diabetes , such as those who are overweight , have a family history of diabetes , or have a racial or ethnic background associated with an increased risk ( for example , Native American persons ) .  Intensive programs of lifestyle modification ( diet , exercise , and behavior ) should also be considered for patients who have impaired fasting glucose or impaired glucose tolerance , since several large trials have demonstrated that these programs can significantly reduce the incidence of diabetes in these patients . Evidence and recommendations regarding counseling about diet , physical activity , and obesity are provided in the USPSTF evidence summaries Counseling to Promote a Healthy Diet , Counseling to Promote Physical Activity , and Screening and Treatment for Obesity in Adults , available on the Agency for Healthcare Research and Quality Web site at www.preventiveservices.ahrq.gov . The brief review of the evidence that is normally included in USPSTF recommendation statements is available in the complete recommendation and rationale statement on the USPSTF Web site ( www.preventiveservices.ahrq.gov ) . Recommendations of Others The ADA acknowledged that data from prospect i ve studies were insufficient to determine the benefits of diabetes screening and thus concluded that the decision to test for diabetes should be based on clinical judgment and patient preference ( 1 ) . On the basis of expert consensus , the ADA recommends clinicians consider screening for diabetes with the FPG test beginning at age 45 years and at a younger age for individuals with such risk factors as family history , overweight , and hypertension , among others . The American College of Obstetricians and Gynecologists endorses the ADA recommendations ( 2 ) . The American Heart Association recommends measuring fasting blood glucose in persons 20 years of age and older according to risk for diabetes , as part of overall risk assessment for cardiovascular disease ( 3 ) . The Canadian Task Force on Preventive Health Care is currently updating its recommendations on diabetes screening Background : Research on the translation of efficacious lifestyle change programs to prevent type 2 diabetes into community or clinical setting s is needed . Objective : The objective of this study was to examine the reach , implementation , and efficacy of a 6-month lifestyle program implemented in primary care by nurse practitioners ( NPs ) for adults at risk of type 2 diabetes . Methods : The NP sites ( n = 4 ) were r and omized to an enhanced st and ard care program ( one  NP  and one  nutrition session ) or a lifestyle program ( enhanced st and ard care and six NP sessions ) . These NPs recruited adults at risk of diabetes from their practice ( n = 58 ) , with an acceptance rate of 70 % . Results : The program reached a diverse , obese , and moderately low income sample . The NPs were able to successfully implement the protocol s. The average length of the program was 9.3 months . Attendance was high ( 98 % ) , and attrition was low ( 12 % ) . The NPs were able to adopt the educational , behavioral , and psychosocial strategies of the intervention easily . Motivational interviewing was more difficult for NPs . Mixed-model repeated- measures analysis indicated significant trends or improvement in both groups for nutrition and exercise behavior . Participants of the lifestyle program demonstrated trends for better high-density lipoprotein ( HDL ) and exercise behavior compared with the enhanced st and ard care participants . Twenty-five percent of lifestyle participants met treatment goals of 5 % weight loss compared with 11 % of st and ard care participants . Discussion : A lifestyle program can be implemented in primary care by NPs , reach the targeted population , and be modestly successful . Further research is indicated Background A negative diabetes screening test may unintentionally provide reassurance , result ing in reduced incentive to follow a healthy lifestyle . Purpose The purpose of this study is to assess negative test result effects on lifestyle and risk perception at 4 years follow-up . Methods Risk perception and changes in smoking , physical activity , body mass index ( BMI ) , and waist circumference were compared between 706 high-risk participants with a negative test result and 706 high-risk participants not offered screening ( controls ) in a r and omized controlled trial of diabetes screening . Results Negative-screened individuals experienced a small but significant increase in BMI and waist circumference , but there was no significant difference with controls . The negative-screened group had significantly higher perception of risk of developing diabetes ( p = 0.009 ) than controls , but no differences were observed in perceived personal control , worry , and optimistic bias . ConclusionS creening negative for diabetes did not lead to overt long-term changes in lifestyle , despite a high perception of risk of developing diabetes . ( IS RCT N75983009 . Background Earlier diagnosis followed by multi-factorial cardiovascular risk intervention may improve outcomes in Type 2 Diabetes Mellitus ( T2DM ) . Latent phase identification through screening requires structured , appropriately targeted population -based approaches . Providers responsible for implementing screening policy await evidence of clinical and cost effectiveness from r and omised intervention trials in screen-detected T2DM cases . UK South Asians are at particularly high risk of abnormal glucose tolerance and T2DM . To be effective national screening programmes must achieve good coverage across the population by identifying barriers to the detection of disease and adapting to the delivery of earlier care . Here we describe the rationale and methods of a systematic community screening programme and r and omised controlled trial of cardiovascular risk management within a UK multiethnic setting ( ADDITION-Leicester ) . Design A single-blind cluster r and omised , parallel group trial among people with screen-detected T2DM comparing a protocol driven intensive multi-factorial treatment with conventional care . Methods ADDITION-Leicester consists of community-based screening and intervention phases within 20 general practice s coordinated from a single academic research centre . Screening adopts a universal diagnostic approach via repeated 75g-Oral Glucose Tolerance Tests within an eligible non-diabetic population of 66,320 individuals aged 40 - 75 years ( 25 - 75 years South Asian ) . Volunteers also provide detailed medical and family histories ; complete health question naires , undergo anthropometric measures , lipid profiling and a proteinuria assessment . Primary outcome is reduction in modelled Coronary Heart Disease ( UKPDS CHD ) risk at five years .  Seven thous and ( 30 % of South Asian ethnic origin ) volunteers over three years will be recruited to identify a screen-detected T2DM cohort ( n = 285 ) powered to detected a 6 % relative difference ( 80 % power , alpha 0.05 ) between treatment groups at one year . R and omisation will occur at practice -level with newly diagnosed T2DM cases receiving either conventional ( according to current national guidelines ) or intensive ( algorithmic target-driven multi-factorial cardiovascular risk intervention ) treatments . Discussion ADDITION-Leicester is the largest multiethnic ( targeting > 30 % South Asian recruitment ) community T2DM and vascular risk screening programme in the UK . By assessing feasibility and efficacy of T2DM screening , it will inform national disease prevention policy and contribute significantly to our underst and ing of the health care needs of UK South Asians . Trial registration Clinical trial.gov ( NCT00318032 ) The Diabetes Prevention Program is a r and omized clinical trial testing strategies to prevent or delay the development of type 2 diabetes in high-risk individuals with elevated fasting plasma glucose concentrations and impaired glucose tolerance . The 27 clinical centers in the U.S. are recruiting at least 3,000 participants of both sexes , approximately 50 % of whom are minority patients and 20 % of whom are > or = 65 years old , to be assigned at r and om to one of three intervention groups : an intensive lifestyle intervention focusing on a healthy diet and exercise and two masked medication treatment groups -- metformin or placebo -- combined with st and ard diet and exercise recommendations .  Participants are being recruited during a 2 2/3-year period , and all will be followed for an additional 3 1/3 to 5 years after the close of recruitment to a common closing date in 2002 . The primary outcome is the development of diabetes , diagnosed by fasting or post-challenge plasma glucose concentrations meeting the 1997 American Diabetes Association criteria . The 3,000 participants will provide 90 % power to detect a 33 % reduction in an expected diabetes incidence rate of at least 6.5 % per year in the placebo group . Secondary outcomes include cardiovascular disease and its risk factors ; changes in glycemia , beta-cell function , insulin sensitivity , obesity , diet , physical activity , and health-related quality of life ; and occurrence of adverse events . A fourth treatment group -- troglitazone combined with st and ard diet and exercise recommendations --was included initially but discontinued because of the liver toxicity of the drug . This r and omized clinical trial will test the possibility of preventing or delaying the onset of type 2 diabetes in individuals at high risk INTRODUCTION Although the Diabetes Prevention Program and other clinical trials demonstrated the efficacy of intensive lifestyle interventions ( ILI ) and metformin to prevent type 2 diabetes , no studies have tested their comparative effects in pragmatic setting s. This study was design ed to compare the real-world effectiveness of ILI , metformin , and st and ard care among Hispanic women ( Latinas ) with prediabetes . STUDY DESIGN RCT . SETTING / PARTICIPANTS Ninety-two Latinas , who had a mean hemoglobin A1c of 5.9 % , BMI of 33.3 kg/m2 , and waist circumference of 97.4 cm ( 38.3 inches ) , were recruited from an urban community and r and omly assigned to ILI , metformin , or st and ard care using 1:1:1 allocation . Data were collected from 2013 - 2015 and analyzed in 2016 . INTERVENTION The 12-month ILI was adapted from the Diabetes Prevention Program 's ILI and delivered by community health workers ( promotoras ) over 24 sessions . Metformin participants received 850 mg twice daily . Those r and omized to st and ard care continued their regular medical care . MAIN OUTCOME MEASURES Weight and secondary outcomes ( waist circumference , blood pressure , hemoglobin A1c , fasting plasma glucose , insulin , and lipids ) were assessed at baseline and 12 months . RESULTS ILI participants demonstrated significantly greater mean weight loss ( -4.0 kg , 5.0 % ) than metformin ( -0.9 kg , 1.1 % ) and st and ard care participants ( + 0.8 kg , 0.9 % ) ( p<0.001 ) . The difference in weight loss between metformin and st and ard care was not significant . The ILI group experienced a greater reduction in waist circumference than st and ard care ( p=0.001 ) , and a marginal improvement in hemoglobin A1c compared with metformin and st and ard care ( p=0.063 ) . CONCLUSIONS In the first comparative effectiveness trial of diabetes prevention treatments , a 12-month ILI produced significantly greater weight loss than metformin and st and ard care among Latinas with prediabetes . These data suggest that ILI delivered by promotoras is an effective strategy for preventing diabetes in this high-risk group , which may be superior to metformin . Future pragmatic trials involving larger sample s should examine differences in diabetes incidence associated with these treatments OBJECTIVE Glycated hemoglobin ( HbA1c ) , a st and ard measure of chronic glycemia for managing diabetes , has been proposed to diagnose diabetes and identify people at risk . The Diabetes Prevention Program ( DPP ) was a 3.2-year r and omized clinical trial of preventing type 2 diabetes with a 10-year follow-up study , the DPP Outcomes Study ( DPPOS ) . We evaluated baseline HbA1c as a predictor of diabetes and determined the effects of treatments on diabetes defined by an HbA1c ≥6.5 % ( 48 mmol/mol ) . RESEARCH DESIGN AND METHODS We r and omized 3,234 nondiabetic adults at high risk of diabetes to placebo , metformin , or intensive lifestyle intervention  and followed them for the development of diabetes as diagnosed by fasting plasma glucose ( FPG ) and 2-h postload glucose ( 2hPG ) concentrations ( 1997 American Diabetes Association [ ADA ] criteria ) . HbA1c was measured but not used for study eligibility or outcomes . We now evaluate treatment effects in the 2,765 participants who did not have diabetes at baseline according to FPG , 2hPG , or HbA1c ( 2010 ADA criteria ) .  RESULTS Baseline HbA1c predicted incident diabetes in all treatment groups . Diabetes incidence defined by HbA1c ≥6.5 % was reduced by 44 % by metformin and 49 % by lifestyle during the DPP and by 38 % by metformin and 29 % by lifestyle throughout follow-up . Unlike the primary DPP and DPPOS findings based on glucose criteria , metformin and lifestyle were similarly effective in preventing diabetes defined by HbA1c . CONCLUSIONS HbA1c predicted incident diabetes . In contrast to the superiority of the lifestyle intervention on glucose-defined diabetes , metformin and lifestyle interventions had similar effects in preventing HbA1c-defined diabetes . The long-term implication s for other health outcomes remain to be determined OBJECTIVE We evaluate whether lifestyle and metformin interventions used to prevent diabetes have durable effects on markers of inflammation and coagulation and whether the effects are influenced by the development of diabetes . RESEARCH DESIGN AND METHODS The Diabetes Prevention Program was a controlled clinical trial of 3,234 subjects at high risk for diabetes who were r and omized to lifestyle , metformin , or placebo interventions for 3.4 years . Diabetes was diagnosed semiannually by fasting glucose and annually by oral glucose tolerance testing . In addition to baseline testing , anthropometry was performed every 6 months ; fasting insulin yearly ; and hs-CRP , tissue plasminogen activator ( tPA ) , and fibrinogen at 1 year and end of study ( EOS ) . RESULTS CRP and tPA levels were unchanged in the placebo group but fell in the lifestyle and metformin groups at 1 year and remained lower at EOS . These reductions were not seen in those who developed diabetes over the course of the study despite intervention . Fibrinogen was lower at 1 year in the lifestyle group . Differences in weight and weight change explained most of the influence of diabetes on the CRP response in the lifestyle group , but only partly in the placebo and metformin groups . Weight , insulin sensitivity , and hyperglycemia differences each accounted for the influence of diabetes on the tPA response . CONCLUSIONS Lifestyle and metformin interventions have durable effects to lower hs-CRP and tPA . Incident diabetes prevented these improvements , and this was accounted for by differences in weight , insulin resistance , and glucose levels OBJECTIVE Educational attainment is inversely associated with type 2 diabetes risk , but it is unknown whether education impacts individuals ' diabetes prevention efforts . We examined the comparative efficacy of intensive lifestyle intervention and metformin by educational attainment among participants in the Diabetes Prevention Program ( DPP ) , an ongoing U.S. multi-site trial beginning in 1996 . METHODS We studied 2,910 DPP participants r and omized to receive lifestyle intervention , metformin , or placebo .  Stratifying by educational attainment , diabetes incidence and relative risk reductions by treatment assignment were estimated using Cox proportional hazards regression . RESULTS 47 % of participants had completed college and 53 % had not . Compared to placebo , lifestyle participants who had completed college demonstrated a 68 % reduction in diabetes incidence ( 95 % CI=56 , 77 ) , whereas those with less education experienced a 47 % risk reduction ( 95 % CI=29 , 61 ) . For metformin participants , college graduates experienced a 49 % relative risk reduction ( 95 % CI=33 , 62 ) , compared to 23 % ( 95 % CI=1 , 41 ) among those with lower educational attainment . There was a statistically significant education-by-treatment interaction with incident diabetes ( p=0.03 ) . CONCLUSIONS Intensive lifestyle intervention and metformin have greater efficacy among highly educated individuals . Future efforts to deliver these treatments and study their dissemination may be more effective if tailored to individuals ' educational background
Conclusions HbA1c is neither sensitive nor specific for detecting pre‐diabetes ; fasting glucose is specific but not sensitive .
Interventions in people classified through screening as having pre‐diabetes have some efficacy in preventing or delaying onset of type 2 diabetes in trial population s. As screening is inaccurate , many people will receives an incorrect diagnosis and be referred on for interventions while others will be falsely reassured and not offered the intervention .
These findings suggest that “ screen and treat ” policies alone are unlikely to have substantial impact on the worsening epidemic of type 2 diabetes .
& NA ; Objectives To assess diagnostic accuracy of screening tests for  pre‐diabetes  and efficacy of interventions ( lifestyle or metformin ) in preventing onset of type 2 diabetes in people with pre‐diabetes .