Can diabetes mellitus be prevented? - abstract

ABSTRACT

Many secondary and tertiary interventions have proven effective in preventing the complications of diabetes mellitus. Of note, The Diabetes Control and Complications Trial has established that intensive treatment of diabetes mellitus with the goal of normo-glycaemia delays the development and slows the progression of renal failure. Screening and photocoagulation for macular oedema and proliferative retinopathy are highly effacious at reducing the progression of these complications to blindness. It is estimated that more than half of the non-traumatic amputations in diabetics can be prevented by appropriate education, footcare and early intervention for trauma, ulcer and infection. Patients and purveyors of care to patients with diabetes mellitus should institute these interventions in their patients to reduce the long-term effects of hyperglycaemia. At present, however, there are no interventions which have been proven to prevent development (primary prevention) of diabetes mellitus. Several large scale trials (Diabetes Prevention Trial - Type 1 Diabetes (DPT-1), European Nicotinamide Diabetes Intervention Trial (ENDIT), European Insulin Trial (EUROINS) are underway to try and prevent IDDM by administration of nicotinamide or insulin to individuals with increased risk of developing diabetes mellitus. Large scale studies of primary prevention studies of NIDDM are planned or are underway. Primary prevention of diabetes mellitus is intuitively attractive. Chronic disease models indicate that the delaying of the onset of diabetes mellitus enhances the effect of intensive treatment on reducing complications, and that the combined approach is more effective than either alone. It is appropriate to allocate research resources to large-scale clinical trials of diabetes primary prevention at this time. Trials of immunomodulation of the natural history of IDDM is supported by work in animals and pilot studies in man. Epidemiological studies suggest that lifestyle interventions such as diet and exercise may prevent development of NIDDM in susceptible individuals, and drugs that affect insulin secretion and/or action are also potential candidates for primary prevention of NIDDM (AU)