Disclaimer: The following guide is my best guess on what content will be on the exam. I do not know what exactly will be on the exam but I have helped over a thousand health care professionals pass the exam.
Chapter 5- Reducing the Risk of Developing Diabetes
Importance: High- Re-read a few times, be familiar with chapter-
Approximate time recommended: 60 min
I have highlighted what I think will be important for the exam. All areas in grey (key messages and recommendations) are also important for the exam. However you should read the entire chapter.
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Open in new tab Under the heading of: Reducing the Risk of Developing Type 1 Diabetes
The main message is that we don’t have enough information/agreement of information to recommend anything in particular for preventing type 1 diabetes (just like in screening for type 1 diabetes)
Reducing the Risk of Developing Type 2 Diabetes
Type 2 diabetes costs the healthcare system a lot of money. We could save a lot of money by preventing the development of type 2 diabetes. This is where you can apply your knowledge by giving patients clear facts and encouraging/guiding them with lifestyle changes.
Healthy Behaviour Interventions
Lifestyle changes can have a powerful effect in reducing the progression from pre-diabetes to type 2 diabetes. Several studies show the diet, exercise and weight loss of 5% can reduce the progression by ~60% which is a more powerful effect than some medications! Metformin reduce the progression by about 30-40% and acarbose by ~30% so lifestyle changes were roughly twice as effective. I find that when patients hear that there could be a ~60% risk reduction in them progression from pre-diabetes to type 2 diabetes they get excited as 60% is a big number. This is a great time to set reasonable goals, give guidance and establish follow up with patients with pre-diabetes.
Medical Nutrition Therapy
Dietitians interventions has been shown to reduce the progression of pre-diabetes to type 2 diabetes
Dietary Patterns
Be familiar with the Mediterranean and the DASH diet. It will be further explained in the Chapter 11.
Physical Activity
These studies established the recommended goal of 150 min/week of physical exercise.
Under the heading of: Pharmacotherapy
Metformin reduces the progression by ~30%. It seems to work better on people who are younger and/or obese
Thiazolidinediones like Rosiglitazone (Avandia) and Pioglitazone (Actos) showed significant reductions in progression from 60-70%. However rosiglitazone is not used much more anymore because one study found that it may increase cardiovascular events, it will likely not be on the exam. Pioglitazone also has many side effects such as weight gain, possible bladder cancer and increased fractures so is falling out of favor but will likely still be on the exam.
Acarbose (Glucobay) showed reductions of progression by ~30%
Orlistat (Xenical) is a medication for weight loss (not diabetes) that inhibits fat absorption causing diarrhea and steatorrhea (fat in feces). Its poorly tolerated unless the patient is strict with their diet. However for patients who were able to stick with this medication, orlistat reduces progression by ~30-40%
Patients with obesity taking Liraglutide (Victoza) took 2.7 times longer to develop diabetes.
Vitamin D had not effect.
Bariatric Surgery
Since all surgery has it’s risks the risk/benefit ratio of bariatric surgery for diabetes prevention is unclear
Diabetes Prevention in High-Risk Ethnicities
People with African, Arab, Asian, Hispanic, Indigenous and South Asian ethnicities are at higher risk for diabetes (I find it easier to remember the list as non-Caucasian).
Population Level Interventions for Prevention of Type 2 Diabetes
The incidence of diabetes has been increasing due to several factors and are complex. Be familiar with Figure 1 .
Practice Questions (press show answer to reveal answer)
Which of the following does not help with preventing the progression of pre-diabetes to type 2 diabetes
A) Nicotinamide
B) Pioglitazone
C) Orlistat
D) Acarbose