endocrine and metabolic disorders
Diabetes Mellitus (DM)
Prevention of Diabetes Mellitus
There are no current therapies to completely prevent type 1 diabetes. (14-day course) versus placebo resulted in a median 24-month delay in time to diagnosis of type 1 diabetes in the initial trial ( Prevention references ) and 33 months in a follow-up study ( , induce remission of early type 1 diabetes in some patients, but longer term studies have not shown benefits ( Prevention references ). (CTLA-4-Ig) have shown some promise in preserving beta-cell function in recent-onset type 1 diabetes and are being investigated ( Prevention references , Patients with impaired glucose regulation should receive counseling addressing their risk of developing diabetes and the importance of lifestyle changes for preventing diabetes. They should be monitored closely for development of diabetes symptoms or elevated plasma glucose. Ideal follow-up intervals have not been determined, but annual or biannual checks are probably appropriate. 50% ( Prevention references ). 35 or history of gestational diabetes) ( Prevention references , In patients with obesity, pharmacotherapy for weight loss, medical devices, and weight loss surgery can be used as adjuncts to diet and physical activity (see Weight loss ). Metabolic surgery ( Risk of Complications of Diabetes Mellitus can be decreased by strict control of plasma glucose, defined as HbA1C 1.Herold KC, Bundy BN, Long SA, et al. An Anti-CD3 Antibody,Teplizumab, in Relatives at Risk for Type 1 Diabetes [published correction appears inN Engl J Med2020 Feb 6;382(6):586].N Engl J Med2019;381(7):603-613. doi:10.1056/NEJMoa1902226 2.Sims EK, Bundy BN, Stier K, et al.Teplizumabimproves and stabilizes beta cell function in antibody-positive high-risk individuals.Sci Transl Med2021;13(583):eabc8980. doi:10.1126/scitranslmed.abc8980 3.Martin S, Schernthaner G, Nerup J, et al. Follow-up ofcyclosporin Atreatment in type 1 (insulin-dependent) diabetes mellitus: lack of long-term effects.Diabetologia1991;34(6):429-434. doi:10.1007/BF00403182 4.Nagy G, Szekely TE, Somogyi A, Herold M, Herold Z. New therapeutic approaches for type 1 diabetes: Disease-modifying therapies.World J Diabetes2022;13(10):835-850. doi:10.4239/wjd.v13.i10.835 5.Forlenza GP, McVean J, Beck RW, et al. Effect ofVerapamilon Pancreatic Beta Cell Function in Newly Diagnosed Pediatric Type 1 Diabetes: A Randomized Clinical Trial.JAMA2023;329(12):990-999. doi:10.1001/jama.2023.2064 6.Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention ormetformin.N Engl J Med2002;346(6):393-403. doi:10.1056/NEJMoa012512 7.Hostalek U, Gwilt M, Hildemann S. Therapeutic Use ofMetforminin Prediabetes and Diabetes Prevention.Drugs2015;75(10):1071-1094. doi:10.1007/s40265-015-0416-8 8.American Diabetes Association: Standards of Medical Care in Diabetes.Diabetes Care46 (Supplement 1): 1-291, 2023. 9.Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery.N Engl J Med2004;351(26):2683-2693. doi:10.1056/NEJMoa035622 