Northeast Ohio Medical University, Rootstown, OH.
Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD.
Diabetes Care. 2023 Feb 1;46(2):e39-e50. doi: 10.2337/dc22-0620.
Individuals with an elevated fasting glucose level, elevated glucose level after glucose challenge, or elevated hemoglobin A1c level below the diagnostic threshold for diabetes (collectively termed prediabetes) are at increased risk for type 2 diabetes. More than one-third of U.S. adults have prediabetes but fewer than one in five are aware of the diagnosis. Rigorous scientific research has demonstrated the efficacy of both intensive lifestyle interventions and metformin in delaying or preventing progression from prediabetes to type 2 diabetes. The National Clinical Care Commission (NCCC) was a federal advisory committee charged with evaluating and making recommendations to improve federal programs related to the prevention of diabetes and its complications. In this article, we describe the recommendations of an NCCC subcommittee that focused primarily on prevention of type 2 diabetes in people with prediabetes. These recommendations aim to improve current federal diabetes prevention activities by 1) increasing awareness of and diagnosis of prediabetes on a population basis; 2) increasing the availability of, referral to, and insurance coverage for the National Diabetes Prevention Program and the Medicare Diabetes Prevention Program; 3) facilitating Food and Drug Administration review and approval of metformin for diabetes prevention; and 4) supporting research to enhance the effectiveness of diabetes prevention. Cognizant of the burden of type 1 diabetes, the recommendations also highlight the importance of research to advance our understanding of the etiology of and opportunities for prevention of type 1 diabetes.
个体的空腹血糖水平升高、葡萄糖负荷后血糖水平升高或糖化血红蛋白水平升高但低于糖尿病的诊断阈值（统称为糖尿病前期），其患 2 型糖尿病的风险增加。超过三分之一的美国成年人患有糖尿病前期，但不到五分之一的人意识到这一诊断。严格的科学研究已经证明了强化生活方式干预和二甲双胍在延缓或预防糖尿病前期向 2 型糖尿病进展方面的疗效。国家临床护理委员会（NCCC）是一个联邦咨询委员会，负责评估和提出建议，以改善与预防糖尿病及其并发症相关的联邦项目。在本文中，我们描述了 NCCC 一个主要关注预防糖尿病前期人群 2 型糖尿病的小组委员会的建议。这些建议旨在通过以下方式改善当前的联邦糖尿病预防活动：1）提高对人群中糖尿病前期的认识和诊断；2）增加国家糖尿病预防计划和医疗保险糖尿病预防计划的可及性、转诊和保险覆盖范围；3）促进食品和药物管理局审查和批准二甲双胍用于预防糖尿病；4）支持研究，以提高糖尿病预防的效果。鉴于 1 型糖尿病的负担，这些建议还强调了研究的重要性，以增进我们对 1 型糖尿病病因和预防机会的理解。
