Prevention of type1 diabetes mellitus: Type1 diabetes is less genetically predisposed. There is still no success in preventing diabetes type1. But animal model have show promise in type1 diabetes prevention and it is possible to prevent or delay diabetes successfully in animal models. Some interventions have targeted the immune system directly by suppression of immunity and induction of immunologic tolerance to islet proteins of pancreas. Other interventions have prevented islet cell death by blocking cytotoxic cytokines or increasing islet resistance to the destructive process. In humans it has not been successful to reproduce the animal model results. Administration of insulin to individuals at high risk for developing type1 diabetes did not prevent type1 diabetes.
Prevention of type1 diabetes mellitus: Type2 diabetes is amenable to prevention. Type2 diabetes is preceded by Impaired Glucose Tolerance (IGT). Persons with IGT and high risk of diabetes, a number of lifestyle modifications and pharmacologic agents prevent or delay the onset of diabetes. The Diabetes Prevention Program (DPP) of USA has shown that changes in lifestyle like, diet and aerobic exercise for 30 min/day five times/week, in individuals with IGT and high risk individuals prevented or delayed the development of type2 diabetes by 58% compared to placebo. This delay and prevention of diabetes is seen in all individuals regardless of age, sex, or ethnic group. Among hypoglycemic (reduced blood glucose level) drugs metformin prevent or delay diabetes. metformin, acarbose, thiazolidinediones, and orlistat prevent or delay type2 diabetes but are not approved for this purpose. Pravastatin reduces the number of new cases of diabetes if given for the treatment of cardiac problems and as cholesterol lowering agent.
American Diabetic Association (ADA) recommends use of metformin (but not other hypoglycemics) in individuals with IGT who are at very high risk for developing diabetes i.e. age more than 60 years, BMI of 35 or above, family history of diabetes in first-degree relatives, increased triglycerides, reduced HDL, hypertension. But the best strategy with a strong family history of type2 diabetes and IGT is to maintain a normal BMI and engage in regular physical activity.
