TYPE 1 DIABETES:
The autoimmune process in Type 1 diabetes begins years before β-cells are destroyed. Measuring HLA susceptibility markers and autoantibody tests allows those at high risk of developing the disease to be identified.
At present there is no reliable method of preventing its development. Studies in small groups of children have shown that aggressive insulin therapy in those likely to develop Type 1 diabetes may delay the development of the condition as a result of reduced βcell activity.
Cyclosporin has been shown to induce remission for one year in 50% of patients with Type 1 diabetes of short duration. However, the effect only lasts for the duration of therapy and the nephrotoxicity of the drug has halted further trials.
Nicotinamide has also been shown to delay the progression to Type 1 diabetes in susceptible individuals, probably through its action on deoxyribonucleic acid (DNA) synthesis and increasing β-cell regeneration.
Although there is great interest in the area of Type 1 diabetes prevention, there are still no definitive positive results from intervention studies and trials.
TYPE 2 DIABETES:
The global epidemic of Type 2 diabetes, driven by changes in diet and physical inactivity, is potentially preventable through the institution of appropriate public health measures. These can be targeted at small groups of high-risk individuals or at whole communities. Studies have now shown that measures aimed at altering lifestyle can prevent the progression of glucose intolerance to full blown Type 2 diabetes.
In the Finnish Diabetes Prevention Study, an individualized programme combining weight reduction, a healthy diet and increased physical exercise reduced the risk by nearly 60%.
Exercise has also been shown to prevent Type 2 diabetes independently in those who are overweight or who have impaired glucose tolerance.
It is possible to identify individuals at higher risk of developing diabetes since there are a number of predictive risk factors. Preventative advice for those at risk of Type 2 diabetes should include the following:
Recommendation of a healthy diet which is high in fibre and low in saturated fat, regular aerobic exercise, avoiding cigarette smoking and avoiding obesity.
E214 – The Prevention of Type 1 and Type 2 Diabetes – www.diabetic.today