Prévention du diabète de tyPe 2 et de ses comPlications

Type 2 diabetes (T2D) represents a major medical and public health problem. The ability to prevent or delay T2D by modifying some of its risk factors has been hypothesized for several decades. Indeed, the slow and gradual deterioration of glycaemia prior to the diabetes diagnosis constitutes a period during which interventions could be effective in preventing T2D. Lifestyle modifications demonstrated that modest weight loss (at least 7% of initial weight) and moderate to intense physical activity of at least 150 minutes per week, markedly and significantly delayed the onset of T2D in subjects at high risk of developing the disease. Pharmacological interventions indicated that metformin should be considered, particularly in young patients (< 60 years) with a body mass index ≥ 35 kg/m2, and in women with a history of gestational diabetes. Bariatric surgery, which allows significant weight loss in subjects with severe or morbid obesity, has also demonstrated important preventive effectiveness and metabolic surgery in now considered in at-risk patients with less severe obesity. In conclusion, in overweight or obese adults at high risk of developing T2D, treatment aimed at losing weight (including bariatric surgery) and increasing physical activity should be implemented, and a pharmacotherapy might be considered case by case.