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
Family history of diabetes
Maternal history of diabetes
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
Lack of breast-feeding
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
*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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