- Although the Diabetes Prevention Program and other clinical trials demonstrated the efficacy of intensive lifestyle interventions (ILI) and metformin to prevent type 2 diabetes, no studies have tested their comparative effects in pragmatic settings. This study was designed to compare the real-world effectiveness of ILI, metformin, and standard care among Hispanic women (Latinas) with prediabetes.
- The high prevalence and costs of type 2 diabetes makes it a rapidly evolving focus of policy action. Health systems, employers, community organizations, and public agencies have increasingly looked to translate the benefits of promising research interventions into innovative polices intended to prevent or control diabetes. Though guided by research, these health policies provide no guarantee of effectiveness and may have opportunity costs or unintended consequences. Natural experiments use pragmatic and available data sources to compare specific policies to other policy alternatives or predictions of what would likely have happened in the absence of any intervention.
- Type 2 diabetes is common and burdensome. Its risk factors include unhealthful eating, physical inactivity, and obesity, which spare no segment of the population and threaten the health and economic well-being of the entire U.S. society. If left unchecked, one in three children born today are expected to develop diabetes in their lifetimes.1
- One decade ago the U.S. Diabetes Prevention Program (DPP) affirmed two prior international trials by demonstrating that a lifestyle intervention that promoted improved diet, increased physical activity to 150 minutes per week, and modest weight loss could prevent or delay almost 60% of new cases of type 2 diabetes among overweight or obese adults with impaired glucose tolerance, a form of what is commonly now referred to as pre-diabetes.1 Despite this striking research finding, the prevalence of obesity remains today at an all-time high.
- New recommendations about the use of hemoglobin A1c (HbA1c) for diagnosing diabetes have stimulated a debate about the optimal HbA1c cutoff to identify prediabetes for preventive intervention.
- The American Diabetes Association (ADA) recently proposed the use of hemoglobin A1c as a practical and valid strategy to identify high-risk people for whom delivery of an intensive lifestyle intervention to prevent type 2 diabetes is likely to be cost effective.