Many effective diabetes prevention and management strategies are a good value in terms of cost per quality-adjusted life year QALY gained. For example:. Screening to detect complications early in people with diabetes is also a good value and can prevent serious disabilities.
The campaign includes a 1-minute online risk test and links people to organizations across the country that deliver the National DPP lifestyle change program. More than 3. To prevent complications in people living with diabetes, CDC and its partners are working to expand access to and participation in diabetes self-management education and support DSMES services.
DSMES helps people with diabetes effectively manage their blood sugar, blood pressure, and cholesterol and get preventive care. Older cost estimates are likely to be underestimates. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Section Navigation. Facebook Twitter LinkedIn Syndicate. Cost-Effectiveness of Diabetes Interventions. Minus Related Pages. Diabetes in the United States More than 34 million people of all ages about 1 in 10 have diabetes, and 88 million adults 1 in 3 have prediabetes.
Nearly 1 in 5 adolescents aged 12 to 18 years and 1 in 4 young adults aged 19 to 34 have prediabetes. Prevalence of overweight and obesity and their cardiometabolic comorbidities in Hispanic adults living in Puerto Rico. J Community Health. Small area variation in diabetes prevalence in Puerto Rico.
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PLoS Med. Greater whole-grain intake is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. J Nutr. Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose—response meta-analysis of cohort studies. Eur J Epidemiol. White rice consumption and risk of type 2 diabetes: meta-analysis and systematic review. Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults.
Improvement of insulin resistance after diet with a whole-grain based dietary product: results of a randomized, controlled cross-over study in obese subjects with elevated fasting blood glucose. Whole-grain foods do not affect insulin sensitivity or markers of lipid peroxidation and inflammation in healthy, moderately overweight subjects.
Markers of cardiovascular risk are not changed by increased whole-grain intake: the WHOLEheart study, a randomised, controlled dietary intervention. Cereal grains, legumes and diabetes. Eur J Clin Nutr. Bean and rice meals reduce postprandial glycemic response in adults with type 2 diabetes: a cross-over study.
Nutr J. Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial. Potato and french fry consumption and risk of type 2 diabetes in women. Metabolic and hormonal effects of five common African diets eaten as mixed meals: the Cameroon Study. Incorporation of whole, ancient grains into a modern Asian Indian diet to reduce the burden of chronic disease. Effect of novel maize-based dietary fibers on postprandial glycemia and insulinemia.
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Am J Epidemiol. Substituting brown rice for white rice to lower diabetes risk: a focus-group study in Chinese adults. Substituting white rice with brown rice for 16 weeks does not substantially affect metabolic risk factors in middle-aged Chinese men and women with diabetes or a high risk for diabetes.
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Food Sci Technol. Physicochemical characterizing of industrial and tradition nixtamalized corn flours. J Food Eng. Nutrition transition in Mexico and in other Latin American countries. Caloric beverages were major sources of energy among children and adults in Mexico, — Food components and dietary patterns of two different groups of Mexican lactating women.
Perfiles de Nutricion por Pais. Costa Rica. Comparison of dietary intakes of micro- and macronutrients in rural, suburban and urban populations in Costa Rica.
Uauy R, Monteiro CA. The challenge of improving food and nutrition in Latin America. Food Nutr Bull. Influence of sensory and cultural perceptions of white rice, brown rice and beans by Costa Rican adults in their dietary choices. A preliminary study of a Common Porto Rican Diet. Robinson U, Suarez RM. Fernandez NA. These individuals have a high risk for the development of diabetes Centers for Disease Control and Prevention Type 2 diabetes is associated with considerable morbidity and mortality, which can lead to substantial personal and societal costs Yach et al This estimate does not include many intangible costs, such as pain and suffering.
Cardiovascular disease CVD is the leading cause of death among diabetics, and is responsible for much of the increase in diabetes-related morbidity and mortality.
Atherosclerosis, hypertension, and stroke are common problems affecting individuals with diabetes, all of which correlate highly with the presence of obesity Centers for Disease Control and Prevention ; Glendening et al A cluster of interrelated cardiometabolic risk factors is closely related to the development of type 2 diabetes and cardiovascular disease.
Current views suggest that cardiometabolic risk factors represent a continuum of disease risks — not merely the presence or absence of a distinct disease entity Eckel et al Obesity, hyperglycemia and insulin resistance, dyslipidemia, inflammation, and hypertension represent interrelated therapeutic targets in the battle against the increasing prevalence of type 2 diabetes Eckel et al There is epidemiologic and physiologic evidence linking insulin resistance and hyperglycemia which precedes and characterizes the development of type 2 diabetes to the presence of abdominal obesity Diabetes Research Working Group ; Sharma An association between intra-abdominal adipose tissue and insulin resistance has been demonstrated in animal models and in human subjects Raz et al , and increased abdominal adipose tissue greatly increases the risk of developing IGT and insulin resistance in individuals with normal glucose tolerance at baseline Hayashi et al The underlying mechanisms involve the increased flux of free fatty acids FFAs to the liver, pancreas, and other tissues, and subsequent deposition of triglycerides TG Lewis et al ; Raz et al This process is related to excessive release by adipose tissue of assorted bioactive substances known as adipokines Chandran et al , the combined actions of which trigger a chronic inflammatory state that contributes to the development of insulin resistance Xu et al Elevated circulating FFA levels cause tissues to become resistant to the action of insulin.
In addition to adverse pancreatic effects, the excess glucose and fat in the blood can lead to additional organ and vascular damage, which underlies much of the morbidity and mortality associated with diabetes Deedwania and Fonseca ; Centers for Disease Control and Prevention The mechanisms by which abdominal obesity contribute to cardiometabolic risk appear to involve the endocrine activity of adipose tissue Kershaw and Flier Adipose tissue and specifically abdominal adipose cells secrete a number of cytokines and adipokines that can have deleterious cardiometabolic effects.
These include effects on glucose control, lipid profile, increased thrombotic risk, and increased inflammatory state Lewis et al ; Goldstein These cytokines in turn induce expression of the adipocyte-derived secretory protein resistin, which has been implicated in induction of the inflammatory cascade that contributes to the development of insulin resistance Lehrke et al Additional adipokines that play a role in cardiometabolic risk include the thrombotic and fibrinolytic factors plasminogen-activator inhibitor type 1 PAI-1 and fibrinogen Matsuzawa ; Natali et al ; Sharma , and components of the renin-angiotensin system RAS that are involved in the pathogenesis of hypertension, endothelial dysfunction, and the development of insulin resistance Reaven et al ; Caglayan et al ; Sharma Adiponectin, a serum protein synthesized exclusively by adipocytes, plays a role in cardiometabolic pathology Scherer et al ; Hu et al This adipokine is a modulator of insulin sensitization, lipid metabolism, and inflammatory states Chandran et al ; Kadowaki et al ; Matsuzawa In contrast to many of the inflammatory adipokines related to atherogenesis, and induction of insulin resistance, adiponectin has reduced expression under conditions of abdominal obesity, type 2 diabetes, and insulin resistance Weyer et al ; Chandran et al ; Schulze et al ; Schulze et al Increased adiponectin levels are associated with lower hyperglycemia, dyslipidemia, and inflammation in diabetic individuals, and appear protective against the development of type 2 diabetes in individuals at risk Lindsay et al ; Krakoff et al ; Spranger et al Low adiponectin levels are independently predictive of eventual type 2 diabetes even in apparently healthy non-obese individuals Lindsay et al ; Spranger et al and in patients with coronary artery disease and IFG Knobler et al Genetic variability is attributable to plasma adiponectin levels and may be an independent cardiovascular risk factor in diabetic individuals Qi et al Although the mechanisms underlying the protective role of adiponectin are under investigation, several models have been proposed.
These include adiponectin-mediated modification of the insulin receptor in skeletal muscle, leading to enhanced signaling; increased FFA oxidation in skeletal muscle and liver, leading to a decrease in FFA flux; and decreased vascular inflammation through adiponectin-mediated effects on monocyte adhesion and on vascular proliferation of smooth muscle cells Chandran et al Prediabetes or IGT is a major risk factor for diabetes, as are obesity, physical inactivity, and insulin resistance.
The results of major, randomized, controlled clinical studies on the prevention of type 2 diabetes are summarized in Figure 1. See text for study details. The benefit of lifestyle modification was similar for the lean and overweight subgroups. The Finnish study Tuomilehto et al compared the impact of lifestyle modification involving intensive individualized diet counseling and increased physical activity intervention group with that of brief diet and exercise counseling control group in obese males with IGT.
After an average follow-up of 3. There was a clear correlation between diabetes risk reduction and the extent to which weight and activity goals were achieved. The impact of lifestyle intervention on insulin sensitivity and secretion, as measured using frequently sampled intravenous glucose tolerance testing, was evaluated after 4 years in a subset of these patients Uusitupa et al There was a strong correlation between 4-year changes in insulin sensitivity and changes in weight.
The acute insulin response declined significantly among patients in the control group ie, no intensive lifestyle modification. Importantly, insulin secretion remained stable ie, did not worsen among patients with IGT at baseline who were able to lose weight. The Diabetes Prevention Program DPP is one of the largest and most extensive ongoing clinical trials evaluating this issue Knowler et al Intensive nutrition and exercise counseling, metformin therapy, and placebo were compared among obese individuals with IGT in a randomized, controlled format.
The latter 2 interventions were combined with standard diet and exercise recommendations. Following the 2. Thiazolinedione troglitazone also has been evaluated as a preventive agent. The TRIPOD study monitored Hispanic women with a history of previous gestational diabetes who were randomized to receive either troglitazone or placebo Buchanan et al The DPP group conducted a long-term comparison of treatment with metformin, troglitazone, placebo, or intensive lifestyle intervention in patients with IGT Knowler et al During the study, concerns arose over the potential liver toxicity of troglitazone, leading to discontinuation of this study arm and the withdrawal of troglitazone from clinical use.
Prior to troglitazone discontinuation mean time of 0. This protective effect observed in the troglitazone group persisted for 8 months after discontinuation of the study drug. All patients were instructed to follow a weight-reducing or maintaining diet and were encouraged to exercise regularly.
After the mean follow-up period of 3. This treatment generally was well tolerated; the most common adverse events that occurred during acarbose treatment were gastrointestinal effects such as flatulence and diarrhea.
All participants were given information on diet and lifestyle modifications to delay or prevent diabetes. After the median follow-up of 3 years, diabetes or death was the outcome for The XENical in the Prevention of Diabetes in Obese Subjects XENDOS trial was a 4-year, randomized, double-blind, placebo-controlled study conducted in 3, obese individuals to evaluate the efficacy of lifestyle changes in conjunction with either the gastrointestinal lipase inhibitor orlistat or placebo in preventing or delaying type 2 diabetes Torgerson et al This risk reduction was accompanied by a significantly greater mean weight loss in the orlistat group compared with placebo 5.
Further analysis suggested that the reduced risk of developing diabetes could be explained by an effect on the group with IGT at baseline. As expected, the benefits appear to be mediated by effects on multiple potentially causative emerging risk factors related to inflammation, adipokine dysregulation, fibrinolysis, insulin resistance, and glucose metabolism. For example, lifestyle intervention in subjects participating in the Finnish Diabetes Prevention Study was associated with decreased expression of PAI-1 and fibrinogen, both mediators of fibrinolysis Hamalainen et al The thiazolidinediones troglitazone, rosiglitazone, and pioglitazone Ghanim et al ; Samaha et al ; Szapary et al have early anti-inflammatory effects, which are associated with decreased lipolysis and FFA flux, improved insulin signaling and sensitization, increased adiponectin expression, and improved lipid profiles eg, elevated high-density lipoprotein [HDL] cholesterol levels and favorable changes in lipoprotein particle size.
These beneficial effects of thiazolidinediones on cardiometabolic risk factors have been observed in obese and non-obese patients with type 2 diabetes Chiquette et al ; Ghanim et al and in nondiabetic patients with metabolic syndrome Samaha et al ; Szapary et al This interrelationship of factors confirms the concept of metabolic risk being a continuum of disease processes and not merely the absence or presence of one or all of these cardiometabolic risk factors.
Large randomized clinical trials have demonstrated that blockade of the RAS with angiotensin-converting enzyme ACE inhibition or angiotensin receptor blockers ARBs can reduce the incidence of new-onset type 2 diabetes. A recent meta-analysis of 10 randomized clinical trials involving more than 76, patients assessed the potential prevention of diabetes through RAS blockade Scheen a , including 5 trials of ACE inhibitors enalapril, lisinopril, captopril, and ramipril and 4 of ARBs losartan, candesartan, and valsartan.
Among all these trials, new cases of type 2 diabetes were found in 7. Despite these positive findings on the preventive effects of ACE inhibitors, it was recently reported that ramipril included as a treatment arm in the DREAM study failed to reduce the incidence of the primary outcome diabetes or death among participants with IFG or IGT over the median 3-year treatment period Bosch et al However, individuals receiving ramipril in this study were more likely to have normal fasting glucose levels or glucose tolerance at study endpoint than those receiving placebo.
This suggests that the study may not have had adequate power to discern a difference; a longer or larger study might be required for detecting an effect of the ACE inhibitor on the incidence of diabetes. The multiple physiologic actions of angiotensin II may in part explain this complexity Deedwania and Fonseca It is likely that the beneficial actions of RAS blockade involve improvement in both insulin sensitivity and insulin secretion through the impact of multiple mediators on insulin action and receptor signaling, muscle pancreatic islet blood flow, sympathetic nervous activity, adipokine production, and lipid metabolism Scheen b.
There is also evidence that elevated angiotensin II produced by large insulin-resistant adipocytes may inhibit the recruitment of pre-adipocytes, resulting in increased lipid storage in muscle and decreased insulin sensitivity Sharma et al Choose healthy fats.
Limit red meat and avoid processed meat; choose nuts, beans, whole grains, poultry, or fish instead. The researchers also found that the association was strengthened for those who ate healthful plant-based diets [41].
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