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È possibile prevenire l'insorgenza del diabete. Nuove conferme

Modificazioni della stile di vita con o senza aggiunta di metformina possono prevenire lo sviluppo del diabete in soggetti con ridotta tolleranza glucidica. La normalizzazione della regolazione del glucosio e' strettamente dipendente dall'entità del calo ponderale ed è più facile nei soggetti più giovani che hanno di base una buona secrezione di insulina.

Regression from pre-diabetes to normal glucose regulation in the diabetes prevention program

Perreault L, Kahn SE, Christophi CA, Knowler WC, Hamman RF; Diabetes Prevention Program Research Group.

Diabetes Care 2009;32:1583-8

OBJECTIVE: Participants in the Diabetes Prevention Program (DPP) randomized to intensive lifestyle modification (ILS) or metformin had a significantly reduced incidence of diabetes compared with those randomized to placebo, yet most were still at risk because they had pre-diabetes. We explored the effect of baseline characteristics, weight change, ILS, and metformin on regression from pre-diabetes to the lowest-risk state of normal glucose regulation (NGR) defined by American Diabetes Association criteria. RESEARCH DESIGN AND METHODS: The DPP was a prospective randomized trial. Cox proportional hazards modeling was used to identify predictors of regression from pre-diabetes to NGR over 3 years of follow-up. RESULTS: Lower baseline fasting (hazard ratio 1.52, P < 0.01) and 2-h (1.24, P < 0.01) glucose predicted regression to NGR, as did younger age (1.07, P < 0.01) and greater insulin secretion (1.09, P = 0.04). ILS (2.05, P < 0.01) and weight loss (1.34, P < 0.01) had significant and independent effects on regression. A nonsignificant trend for regression was also observed for metformin (1.25, P = 0.06), male sex (1.17, P = 0.08), and insulin sensitivity (1.07, P = 0.09). In those entering the study with both impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), male sex and insulin sensitivity predicted regression to isolated IFG, whereas ILS, metformin, female sex, and greater insulin secretion predicted regression to isolated IGT. CONCLUSIONS: Insulin secretion, and other biologic processes retained with younger age, are key in restoring NGR in people with pre-diabetes. However, NGR may also be attained through weight loss and additional aspects of ILS.