Primary prevention of non insulin dependent diabetes mellitus

ABSTRACT

This work was conducted aiming at early prediction of individual at high risk of development of type 2 diabetes mellitus and evaluation of the efficacy of primary prevention of type 2 DM in such individual by diet control and /or metformin therapy. It was conducted on 100 individuals at high risk of development of type 2DM. Subjects were classified into 3 groups Group I [Individuals with positive family history of DM], 30 cases, subdivided into two equal subgroups, Group la used as control and left without diet control and Group Ib were on diet control. Group II [individuals with upper body segment obesity], 40 cases, subdivided into 3 subgroups Group II a, 10 cases, left without neither diet control nor metformin therapy, Group II b, 15 cases, were on diet control only while Group IIC, 15 cases, were on both diet control and metformin treatment. The third group [Group III] were females with history of gestational diabetes, 30 cases, subdivided into two equal subgroups, Group IIIa used as control and left without diet control, while Group IIIb were on diet control. All cases were subjected to through history taking, complete physical examination, liver function tests, renal function tests, fasting and two hours post-pr and ial plasma glucose estimation, glycosylated haemoglobin [Hb A[1]c] and complete lipid profile. Results showed that individuals with family history of DM had a significant decrease of both FPG and 2HPG together with highly significant decrease in Hb A[1]C after one year of diet control together with significant decrease in total cholesterol, TG and LDL-cholesterol with increase in HDL-cholesterol levels compared to those individuals on free diet reigmen. As regard those with upper body segment obesity, there were significant decreases in both FPG, 2HPG and highly significant decrease in Hb A[1]c in those on diet control and those on both diet control and metformin therapy together with decrease in BMI after one year of follow up compared to those obese with free diet reigmen. This study also showed that females with history of gestational diabetes are more prone to develop type 2DM if left without any diet control since there were significant decrease of both FPG, 2HPG and HbA[1]c levels after one year of follow up. The results of this study showed that diet control has a significant role in preventing or at least delaying the occurrence of type 2DM in those studied high risk groups. Similar effect was obtained by metformin therapy on subjects with upper body segment obesity in preventing the development of type 2DM. Nevertheless, this role need large scale research for long term follow up period to be cleared. The results of this study showed also that, diet control and /or metformin therapy have a significant effect on modification of the different parameters of lipid profile in those individuals which may subsequently have a beneficial effect on reducing or delaying the appearance of the diabetic vascular complications