Diabetes Standards of Care and Resources for Clinicians and Educators

Lifestyle Interventions

The National Institutes of Health-sponsored Diabetes Prevention Program (DPP) clinical trial found that an intensive lifestyle intervention (ILI) lowered diabetes incidence by 58% in individuals at high risk of diabetes.¹ The 16-session ILI established a weight loss goal of 7% from baseline and a physical activity goal of 150 minutes per week. The size of the reduction in diabetes incidence with the ILI was similar in all racial subgroups, including American Indians.

The Diabetes Prevention demonstration projects of the Special Diabetes Program for Indians showed that a Native Lifestyle Balance Curriculum (modified 16-session, 6-month DPP ILI curriculum) could be successfully implemented in AI/AN communities.²

Resources on lifestyle intervention programs for diabetes prevention:

• The Diabetes Prevention Program Toolkit of the SDPI describes how to establish and implement a Diabetes Prevention Program (DPP).
• The Centers for Disease Control and Prevention (CDC) offers curricula and formal recognition of lifestyle change programs through the National DPP. Exit Disclaimer: You Are Leaving www.ihs.gov 
• The Medicare Diabetes Prevention Program Expanded Model Exit Disclaimer: You Are Leaving www.ihs.gov  offers reimbursement for Medicare beneficiaries participating in CDC-recognized diabetes prevention programs.

Metformin

Medications can prevent or delay diabetes development. Metformin, an anti-hyperglycemic agent, reduced diabetes incidence by 31% in the National Institutes of Health DPP trial.¹ Metformin is most effective for diabetes prevention in adults with prediabetes and any of the following characteristics:

• Body mass index of at least 35 kg/m²
• Age less than 60 years
• History of gestational diabetes mellitus

Note: Metformin is U.S. Food and Drug Administration (FDA)-approved for hyperglycemia treatment in people with type 2 diabetes, but not for diabetes prevention.

Other Medications

The medications listed below can prevent or delay diabetes in people with prediabetes, but they do not have FDA approval for diabetes prevention. Providers should discuss the risks and benefits of these agents with patients before prescribing them for diabetes prevention.

Antidiabetes medications:

• Thiazolidinediones (pioglitazone)
• Alpha-glucosidase inhibitor (acarbose)

Weight-loss medications:

• Orlistat (Xenical), a lipase inhibitor
• Liraglutide (Saxenda), a glucagon-like peptide-1 receptor agonist
• Phentermine and topiramate combination (Qsymia), a sympathomimetic-antiepileptic medication

References

1. Knowler W, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; DPP Research Group. A randomized clinical trial to prevent type 2 diabetes in persons at high risk. N Engl J Med 2002;346:393-403. DOI: 10.1056/NEJMoa012512
2. Jiang L, Manson SM, Beals J, Henderson WG, Huang H, Acton KJ, Roubideaux Y; Special Diabetes Program for Indians Diabetes Prevention Demonstration Project. Translating the Diabetes Prevention Program into American Indian and Alaska Native communities: Results from the Special Diabetes Program for Indians Diabetes Prevention demonstration project. Diabetes Care 2013;36:2027-2034. https://doi.org/10.2337/dc12-1250