Is lifestyle modification adequate to prevent onset of diabetes

Metabolic syndrome carries with it the underlying pathophysiologic feature of insulin resistance with tissue resistance to insulin action, compensatory hyperinsulinemia, and excessive circulating free fatty acids [78,79]. In addition, cardiovascular risk factors of low HDL and high triglyceride levels, hypertension, and lack of physical activity have all been shown to be predictors of non-insulin-dependent diabetes [80]. The relationships between metabolic syndrome and cardiovascular mortality as well as chronic complications of type 2 diabetes have been well described [81,82]. Several studies have shown impaired glucose tolerance to be a predictor of progression to type 2 diabetes [8385]. In addition, in one study, adiponectin was an independent predictor of type 2 diabetes [86]. It follows, then, that aggressive intervention in patients with impaired glucose tolerance or metabolic syndrome would translate to diabetes prevention. In addition to the Da Qing study, the Finnish diabetes prevention study and the diabetes prevention program (DPP), several smaller studies

Activation of PI-3K

Activation of P70 S6 Kinase

No production glucose transport Î Acetyl CoA carboxylase

Fig. 4. Angiotensin II, insulin signaling and crosstalk. Ang I, angiotensin II; VSMC, vascular smooth muscle cell.

have reflected the benefit of lifestyle modifications [87-92]. Weight loss programs, dietary modification, and aggressive exercise regimens are fraught with challenges, however [93,94]. As urbanization becomes more widespread, exercise as a modality for weight loss will become increasingly difficult and possibly destined to failure. A group of obese Hawaiians lost 7.8 kg in 3 weeks when they changed their diet to ad libitum feeding of their traditional diet, which provided only 7% of energy

Table 5

Endothelial function improvement and association with prevention of type 2 diabetes

Prevention Improvement Prevention of cardiovascular of endothelial of new-onset

Table 5

Endothelial function improvement and association with prevention of type 2 diabetes

Prevention Improvement Prevention of cardiovascular of endothelial of new-onset

Variable

disease

function

type 2 diabetes

Reference

Exercise and diet

+

+

+

[59]

Statins

+

+

NK

[67]

Ace inhibitors

+

+

+

[29]

ATI blocker

+

NK

+

[33]

PPAR-y gamma

NK

+

+

[68,69]

stimulator

Antioxidants

-

+

NK

[66]

HRT

-

+

NK

[66]

Largininine

NK

+

NK

[66]

Definitions: ATI, angiotensin 1; CVD, cardiovascular disease; HRT, hormone replacement therapy; NK, not known.

Definitions: ATI, angiotensin 1; CVD, cardiovascular disease; HRT, hormone replacement therapy; NK, not known.

as fat, [95]. This change was accomplished without increased exercise, a result that calls into question the value and need for exercise. Weight loss, however, is difficult to accomplish, and, if accomplished, to maintain, so one cannot assume that such strategies to prevent the onset of diabetes are inexpensive. Even in the DPP study, the cost per case of diabetes delayed was similar for lifestyle change and metformin. Pharmacologic interventions that might delay the onset of diabetes should not be ignored but should be considered the context of concurrent lifestyle modifications. The following evidence-based discussion sheds some light on RAAS inhibition and outcomes of new-onset diabetes.

Diabetes 2

Diabetes 2

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...

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