Studies are included if they were either randomized controlled trials (RCTs) or community-based trials, or if they were large, prospective epidemiological studies of sufficient rigor and generalizability to be useful. Some of the historically important studies in diabetes prevention do not meet these criteria for quality but they are mentioned for completeness, with comments about their design or conduct. The numerous clinical, ecological, cross-sectional and retrospective studies that have been conducted have been largely omitted, unless they provide the only evidence bearing on an issue.
Studies were identified through computerized searches of several databases, including Medline, CINAHL, Health Plan, PsycLIT, Helmis, Cochrane Collaboration and Best Evidence. Standard MESH terms were often only partially successful in identifying relevant articles, which were primarily found through a combination of searching published reference lists and contacts with investigators. Unpublished prevention trials were sought through contacts with researchers, although none were found that had been completed but not published. Trials in progress are included in a later section of this chapter. Classification of evidence used in this chapter is shown in Table 6.1, which is based on the US Preventive Service Task Force Criteria28 for individual studies, and NHLBI (National Heart, Lung and Blood Institute of the NIH) evidence criteria29 for overall recommendations.
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...