Jaakko Tuomilehto

Diabetes Care. 2007;30:435-438. http://care.diabetesjournals.org/cgi/content/extract/30/2/435.

The need to prevent type 2 diabetes was recognized as early as the 1920s¹, but surprisingly, little was done to apply preventive measures against this disease in subsequent decades. ^2,3 One of the main problems was the lack of evidence-based or well-conducted studies. There were several clinical trials, but they were usually grossly underpowered, had flaws in design and conduct, and most used antidiabetes drugs as the intervention.³ Luckily, firm positive results from several randomized controlled trials^4-10 using lifestyle intervention have become available during recent years. Also, several properly designed and conducted trials using antidiabetes drugs in individuals at high risk, ie, with intermediate hyperglycemia, have reported favorable results.^8,10-14 The bottom line is that these recent trials have unequivocally demonstrated that it is possible to reduce the rate of progression to type 2 diabetes in high-risk individuals with intermediate hyperglycemia.

Editor's Comment. This issue, I have included 2 different examples of "research literature" available to professionals online. I have expanded the definition of research in this column expressly for the purpose of leading professionals to other sources that provide literature for the healthcare professional. These first 2 abstracts above are actually "excerpts" from a discussion published recently in the journal.

Diabetes Care. This journal is a research-oriented journal of the American Diabetes Association, and articles are available free on the Web site above. This "Point-Counterpoint" discussion raises the issues of medical therapy versus lifestyle therapy in the treatment of type 2 diabetes. Both authors review pertinent parts of the literature; both authors make a strong case for the efficacy of a healthy lifestyle for successful disease management. In fact, Gerstein includes a table showing that lifestyle studies have a lower risk ratio-"RR"-than any of the pharmacological interventions on the table (the end point in those studies was the incidence of type 2 diabetes). These articles are examples of what is in the literature on a relatively frequent basis-that is, discussions of topics of interest to cardiovascular rehabilitation professionals that bring together both areas of research that are of interest and experts to present different viewpoints. Regardless of which view one agrees with, exposure to the literature is always good for increasing understanding and awareness of current topics.

JR