Pre-diabetes Prevention

Lifestyle interventions to prevent Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT)

Recent studies of patients with IGT have shown success for lifestyle interventions in delaying or preventing the development of diabetes. There is strong evidence that a structured program of diet and exercise can reduce the risk of progression to type 2 diabetes in patients with IGT. Patients with IFG and IGT should be advised on the benefits of modest weight loss, good dietary habits, and regular physical activity.

Lifestyle interventions (Table 1) can be difficult to implement because it is impractical for the usual family practice systems to provide intensive dietary and exercise interventions similar to those used in clinical trials. However, lifestyle interventions are highly effective and superior to drug therapy, and should be the first choice in treating patients with IGT or IFG.

Although pharmacologic agents have been shown to be successful in preventing or delaying the onset of diabetes, whether these agents can prevent complications of diabetes or protect against cardiovascular disease remains unknown. Routine use of pharmacologic agents as a substitute for lifestyle modification should be discouraged until more studies have been conducted and the cost-effectiveness of drug therapy has been assessed. A healthier lifestyle can modify other risk factors for cardiovascular disease such as obesity, hypertension, and dyslipidemia. Drug therapy can be considered when aggressive lifestyle interventions are unsuccessful.

TABLE 1
Recommended Lifestyle Changes

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Daily calories
	Fat: <25 to 30 percent
	Saturated fat: <10 percent
	Carbohydrates: 50 to 60 percent
	Protein: 15 to 20 percent
Daily fiber intake: >15 g for every 1,000 calories consumed
Foods: salad, vegetables, fruits, whole grains, fish high in omega-3 fatty acids, legumes,    lean meat; minimal intake of refined sugars
Exercise*: moderate-intensity physical activity, such as brisk walking or biking,     for 150 minutes per week
Weight loss goal*: 5 to 7 percent of body weight
Counseling by professionals on weight reduction and exercise with regular follow-up     and reinforcement

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*—The literature varies as to specific recommendations for weight loss and exercise.

Sources: www.aafp.org, www.wikipedia.com

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