Prevention Of Type Diabetes

Interventions have been targeted at altering a number of behavioral factors including obesity, dietary intake and physical activity. Obesity, of course, should be considered the result of behavioral, genetic and physiological factors and not simply behavioral. Pharmacological interventions have primarily used hypoglycemic or anti-hyperglycemic medication to reverse insulin resistance (biguanides, thiazolidenediones), failure of insulin secretion (sulfonylureas), or glycemic excursions (alpha-glucosidase inhibitors). Trials have attempted to alter glucose metabolism using metal supplementation (magnesium, chromium) or antioxidants (beta-carotene, vitamin E). Trials that have used

Table 6.2. Summary of established and possible* individual level risk factors for type 2 diabetes mellitus

Demographic variables

Obesity-related variables

Older age

Male gender

Ethnic group

Family history of diabetes

Maternal history of diabetes

Higher total adiposity Central fat distribution Intra-abdominal fat Longer duration of obesity Weight gain

Physiological variables

Reproductive variables

High glucose level (fasting and post-challenge) Low insulin secretion Insulin resistance syndrome (low HDL-C, high triglycerides, hypertension, fibrinolytic defects, glucose intolerance) Low magnesium level Low chromium level High plasma non-esterified fatty acids Low sex hormone binding globulin Low physical activity Cigarette smoking

Diabetes during pregnancy

Higher parity

Lack of breast-feeding

Dietary variables

High caloric intake

High total and saturated fat intake

Low alcohol intake

Low fiber intake

High glycemic index foods

Low Vitamin D intake

Low magnesium intake

Low potassium intake

Low polyunsaturated fatty acid intake

Low vegetable fat intake

Low wholegrain intake

*Variables in italics are not firmly established - differing amounts of evidence exist to support them, although the balance of observational data favors them at this time pharmacological interventions to reverse obesity include a wider range of anti-obesity agents, since obesity is one of the common pathways through which diabetes develops. Each of these approaches is reviewed below.

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