This document summarizes key findings from the IDF Diabetes Atlas 2021: 1) An estimated 537 million adults aged 20-79 have diabetes globally in 2021, representing 1 in 10 adults. 6.7 million deaths are attributed to diabetes each year. 2) The top 10 countries for number of adults with diabetes are China, India, USA, Brazil, Pakistan, Indonesia, Mexico, Egypt, Italy, and Bangladesh. The top countries for diabetes healthcare expenditure are USA, China, Japan, Germany, and India. 3) Diabetes prevalence is increasing worldwide, with the majority (75%) of people with diabetes living in low and middle income countries. Cardiovascular disease is the leading cause of death for people

2. 2 | IDF Diabetes Atlas 2021– 10th edition www.idf.org @IntDiabetesFed
Highlights
In 2021, IDF estimates show that:
1 in 2
Adults is undiagnosed
240 million people
11.5%
Of global health expenditure spent
on diabetes (USD 966 billion)
1 in 10
Adults (20-79 years)
has diabetes
537 million people
1 in 6
Live births (21 million) affected
by hyperglycaemia in pregnancy,
80% have mothers with GDM
6.7 million
Deaths attributed to diabetes
1 in 18
Adults (20-79 years) has
impaired fasting glucose
319 million people
1 in 9
Adults (20-79 years) has
impaired glucose tolerance
541 million people
1.2 million
Children and adolescents below
20 years have type 1 diabetes
3 in 4
People with diabetes live in
low and middle-income countries

3. 3 | IDF Diabetes Atlas 2021– 10th edition www.idf.org @IntDiabetesFed
Number of people with diabetes
Aged 20–79 years globally and by IDF region

4. 4 | IDF Diabetes Atlas 2021– 10th edition www.idf.org @IntDiabetesFed
Top 10 countries with diabetes
In adults aged 20–79 years and diabetes-related health expenditure, 2021

5. Represents 2 million people.
Diabetes is mostly (85–95%) T2D.1
• T2D approximately doubles the risk
of death2
• Diabetes caused 4.9 million deaths
in 20141
• CVD is the principal cause of death
in T2D2,3
1.76
1.85
1 1.5 2.0
T2D is increasingly prevalent and CVD is the leading
cause of death in this population
5
1. IDF Diabetes Atlas, 2019. 9th Edition. http://www.idf.org/diabetesatlas.
2. Nwaneri et al. Br J Diabetes Vasc Dis 2013;13:192–207. 3. Morrish et al. Diabetologia 2001;44(suppl 2):S14–21.
• Globally, 463 million people are living
with diabetes1
• Rising to 700 million by 20451
Relative risk for
all-cause mortality
Relative risk for
CV mortality

6. The “common soil” from which type 2
diabetes and cardiovascular disease arise

7. Diabetes is
ASCVD risk
equivalent
N Engl J Med 1998;339:229-34.

8. Modifiable CV risk factors are common in patients
with T2D1,2
8
Almost a third of diabetes patients were current smokers2
1. Svensson et al. Diab Vasc Dis Res 2013;10:520–9. 2. Das et al. Am Heart J 2006;151:1087–93.

10. Copyright ADA/EASD 2022
Ward ZJ et al; NEJM 2019; 381: 2440-2450
https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2022, Accessed 04 June, 2022
https://www.cdc.gov/obesity/data/prevalence-maps.html, Accessed 04 June, 2022

11. Copyright ADA/EASD 2022
Weight Reduction as a Targeted Intervention
• Weight reduction → improve glycemic management and reduce ABCD.
• Weight loss of 5-15% should be a primary target in T2DM.
• More is better
• Loss of 5-10% = metabolic improvement
• Loss of 10-15% = disease-modifying effect + lead to remission of diabetes.
• Weight loss → improve risk factors for cardiometabolic disease and QoL
DaviesMJ,ArodaVR,CollinsBS,GabbayRA,GreenJ,MaruthurNM,RosasSE,DelPratoS,MathieuC,MingroneG,RossingP,TankovaT,TsapasA,BuseJB
DiabetesCare2022;https://doi.org/10.2337/dci22-0034.Diabetologia2022;https://doi.org/10.1007/s00125-022-05787-2.

12. Copyright ADA/EASD 2022
Key Knowledge Gaps
 Study conduct
 Greater attention to subgroups, in particular
vulnerable populations
 Youth, frailty, >75 years of age
 Gender balance
 A minimal first step to enhancing health justice
 Weight management
 Comparative effectiveness
 Targets: A1c, TIR, weight, remission
 Cardiorenal protection
 Comparative effectiveness, Combination therapy,
Cost effectiveness in low/moderate risk population
DaviesMJ,ArodaVR,CollinsBS,GabbayRA,GreenJ,MaruthurNM,RosasSE,DelPratoS,MathieuC,MingroneG,RossingP,TankovaT,TsapasA,BuseJB
DiabetesCare2022;https://doi.org/10.2337/dci22-0034.Diabetologia2022;https://doi.org/10.1007/s00125-022-05787-2.

13. Potential
goals and
approaches
for type 2
diabetes
Diabetes
Prevention
Diabetes
Remission
Prediabetes
Schematic representation Adapted from Raccah et al. Diabetes Metab Res Rev 2007; 23: 257–264
S. Jin et al. / Can J Diabetes 46 (2022) 762e774

14. Diabetes care. 2009 Nov 1;32(11):2133-5.

15. 2021 Definition
• Major diabetes journals published consensus-based remission
definitions, authored by representatives from the ADA, the
EASD, Diabetes UK, the Endocrine Society and the Diabetes
Surgery Summit
• A1C <6.5% without use of antihyperglycemic medications for
at least the 3 prior months.
The Journal of Clinical Endocrinology &
Metabolism. 2022 Jan;107(1):1-9.

17. First of all, it is
a consensus
not a
guideline
We make a consensus to agree on
something that doesn’t have enough
evidence to be written in guidelines
So they agree to not agree
So grades of new recommendations are D
Bariatric surgery and healthy behavioral
intervention have the greatest evidence A

18. Remission not cure

19. Don’t be
afraid but be
cautious

20. Bottomline for terminology
Remission
Not Reversal or
Regression
Not Cure

21. New Definitions
• Type 2 diabetes remission with no antihyperglycemic
medication for at least 3 consecutive months and
achieving an A1C threshold as listed below:
• Remission categories:
remission to normal glucose levels (A1C <6.0%)
remission to prediabetes (A1C between 6.0%
and 6.4%)
• Type 2 diabetes relapse (subsequent A1C ≥6.5%)
• Pharmacologically-managed diabetes (if currently
on antihyperglycemic medication/s)
Can J Diabetes46 (2022) 753 – 761

22. Remission Criteria
A1C criteria: see before
FPG criteria: ≤110 mg/dL for remission to normal
glucose levels or 110 to 125 mg/dL for remission to
prediabetes
OGTT criteria: both FPG [as above] and 2hPG ≤ 140
mg/dL for remission to normal glucose levels or 141
to 199 mg/dL for remission to prediabetes
Can J Diabetes46 (2022) 753 – 761

23. The impact of the concept of diabetes remission on A1C targets
Can J Diabetes46 (2022) 753 – 761

24. Recommendations

25. 3 Categories
1. How to Start
2. How to Follow
3. Options available

26. How to start
Discussion concept of remission + should meet the
specified criteria to eliminate the need for
antihyperglycemic therapy [Grade D, Consensus].
The approach to deprescribing antihyperglycemic agents
should be individualized [Grade D, Consensus].
Can J Diabetes46 (2022) 753 – 761

27. Remission is
more likely
for people:
diagnosed with diabetes for a
shorter time (6 years or less)
with overweight or obesity, who
are ‘able or inclined’ to lose weight
with blood sugars that are not
that elevated
who do not take insulin

28. Other considerations in issue of
remission
without significant eating
disorders or mental health
disorders (present challenges
in adhering to strategies to
achieve diabetes remission
long term)
without cardiovascular
disease, heart failure, or
chronic kidney
disease (because of potential
GLP1 RA and/or SGLT2i
continuation)

29. How to Follow
If type 2 diabetes remission criteria are
met, A1C (or, if A1C unreliable, FPG or
OGTT) should be performed at a
minimum interval of every 6 months to
assess persistence of diabetes remission
or relapse of diabetes [Grade D,
Consensus].
If, at 6 months, remission criteria have
not been met, reinitiation of
antihyperglycemic agents should be
considered.
Can J Diabetes46 (2022) 753 – 761
The Journal of Clinical Endocrinology & Metabolism. 2022 Jan;107(1):1-9.

30. Options Available

31. Approaches to Type 2 Diabetes
Remission
1. Surgical interventions (+/- others below)
2. Pharmacological interventions (+/- others
below)
3. Health behavioral interventions (diet
and/or physical activity not include the
addition of new pharmacological agents or
surgery).
4. Digital technology interventions
Can J Diabetes46 (2022) 753 – 761

32. Cut it down
Bariatric surgery should be recommended
to nonpregnant adults with type 2
diabetes and a BMI ≥35 kg/m2 as an
option to potentially induce type 2
diabetes remission [Grade A, Level 1A]

33. Copyright ADA/EASD 2022
Mingrone et al. The Lancet. 2021 23;397:293-304
Weight Management: Metabolic Surgery

34. Health Behavioral
Interventions
• Low calorie diets (800-850
cal/day) with meal
replacement products for 3-
5 months aimed at
achieving >15kg weight loss,
followed by a structured
food reintroduction program
and increased physical
activity (for people with BMI
27-45) [Grade A, Level 1A].
Can J Diabetes46 (2022) 753 – 761

35. Health Behavioral Interventions (cont.)
• Exercise training (240-420
min/week) with a calorie
restricted diet (for people
with BMI >25, and with a
lower level of evidence for
this option) [Grade C, Level
2]
Can J Diabetes46 (2022) 753 – 761

36. Evidence

37. Trials
DiRECT
DIADEM-I
U-TURN
LookAHEAD trials

38. DiRECT
(Diabetes Remission
Clinical Trial)
• First time randomized trial shows remission of
T2DM with dietary and lifestyle intervention
Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT):
an open-label, cluster-randomised trial. The Lancet 2017

39. Background & Objectives
• T2DM management is focused on
pharmacological treatment
• Caloric restriction is beneficial for T2DM
patients, but not tested in routine primary
care.
• The DiRECT study was designed to assess
whether intensive weight management
can produce sustained remission of T2DM
in the primary care setting.

40. Study design
(1)
Inclusion Criteria
• T2DM diagnosis within the previous 6 years(*)
• age 20–65 years
• BMI: 27 - 45 kg/m2
Exclusion Criteria
• current insulin use
• HbA1c >12%
• weight loss of >5 kg within the past 6 months
• recent eGFR <30 mL/min/1.73m2
• severe or unstable HF
(*) most recent HbA1c value > 6.0%, if HbA1c <6.5% antidiabetic medication was continued

41. Study design (2)
ITT population
(N=298)
Control Group (N=149)
best-practice care by guidelines for up to 52 weeks
Intervention Group (N=149)
stop anti-diabetic and anti-hypertensive medications
Lean MEJ, et al. Lancet 2017
Total Diet Replacement
12-20 weeks
Food Reintroduction
2-8 weeks
Weight Loss Maintenance
up to 52 weeks
ITT: Intention-to-treat;
Total Diet Replacement:
825-853 kcal/day formula;

42. Main results (1/2)
IG: Intervention group; CG: Control group; DM: Diabetes Mellitus;
(*) Additionally, 5% in the CG started antidiabetic medications
Lean MEJ, et al. Lancet 2017
24%
46%
74%
0%
4%
18%
0%
10%
20%
30%
40%
50%
60%
70%
80%
weight loss 15kg or more DM remission drug discontinuation(*)
IG CG
Percentages
of
patients
in
each
group

43. Main results (2/2)
-10
-1
-12
-10
-8
-6
-4
-2
0
IG CG
Mean change in weight (kg)
P<0.0001
-0.9
0.1
-1
-0.8
-0.6
-0.4
-0.2
0
0.2
IG CG
Mean change in HbA1c (%)
P<0.0001
IG: Intervention group; CG: Control group;
Lean MEJ, et al. Lancet 2017

44. DiRECT trial 12-month Bottom-line
Diabetes remission may occur in T2DM of up to 6 years’ duration
with help of an evidence-based structured weight management.
Almost a quarter of participants who followed the intervention
achieved at least 15 kg of weight loss at 12 months.
Almost half of patients (46%) in the IG showed remission of
diabetes and stopped antidiabetic Rx.

45. The 24 month follow up

47. 24-month DiRECT trial bottom-line
36% of intervention
participants had sustained
remission at 24 months
HbA1c was significantly
reduced in the intervention
group, with 50% reduction
in use of diabetes
medications

48. Let’s remit diabetes

49. My Doctor told
me that
diabetes has
gone

50. My Diabetes has not gone

51. Don’t Be So
Enthusiastic

52. Benefits are not only to stop drugs…
• Substantial weight loss is associated with reduced liver and pancreatic
fat, and with restoration of pancreatic morphology and β-cell insulin
secretory capacity = glycemic benefits of loosing weight
• CV benefits of loosing weight
• Obesity itself is a disease, you must deal with it whether or whether not
achieving remission
Lancet Diabetes Endocrinol. 2020; 8: 939-948
Lancet Diabetes Endocrinol. 2019; 7: 726-736

53. Do not negatively impact your
patient
• Sometimes it its difficult, you may not
achieve this
• Weight loss may be difficult, and if occurred
its
• maintenance is difficult “on lifestyle alone”
• Remission is one target, lowering A1C is the
classic most important one
• Don’t underestimate the 1% reduction in A1c

54. Message for those who are on
remission
• You carry risk, you are always at
risk
• You have to see your caregiver
every now and then
• A1c (or others) at 3 month
interval

55. Dilemma
• Insulin during remission
• Starting GLP-1 & SGLT2i for
non glycemic indications
• Diabetes beyond 6 years (what
about 7)
• If not obese at the start
• Blood sugar that not that
elevated

56. Copyright ADA/EASD 2022
Weight Management in Type 2 Diabetes
Davies M et al; Lancet 2021; 397: 971-84
Frías JP et al. N Engl J Med 2021;385:503-515

57. Bottom-line for diabetes remission
• Diabetes remission may be occurring more often due to
advances in treatment
• More research is needed.
• Individualize deprescription
• A1c reduction is enough sometimes
• Remission is one of treatment targets, not the only one

58. Diabetes Prevention

59. AACE Prediabetes

60. Potential
goals and
approaches
for type 2
diabetes
Diabetes
Prevention
Prediabetes
Schematic representation Adapted from Raccah et al. Diabetes Metab Res Rev 2007; 23: 257–264
S. Jin et al. / Can J Diabetes 46 (2022) 762e774

61. 61 | IDF Diabetes Atlas 2021– 10th edition www.idf.org @IntDiabetesFed
Highlights
In 2021, IDF estimates show that:
1 in 2
Adults is undiagnosed
240 million people
11.5%
Of global health expenditure spent
on diabetes (USD 966 billion)
1 in 10
Adults (20-79 years)
has diabetes
537 million people
1 in 6
Live births (21 million) affected
by hyperglycaemia in pregnancy,
80% have mothers with GDM
6.7 million
Deaths attributed to diabetes
1 in 18
Adults (20-79 years) has
impaired fasting glucose
319 million people
1 in 9
Adults (20-79 years) has
impaired glucose tolerance
541 million people
1.2 million
Children and adolescents below
20 years have type 1 diabetes
3 in 4
People with diabetes live in
low and middle-income countries

62. β-Cell Volume in Patients With IFG and Patients With T2D
Butler AE et al. Diabetes 2003;52:102-10

63. Don’t let the
“pre” fool you

64. Heatlh Risks
Associated
With
Prediabetes
64
Prediabetes to diabetes: 4-6% for isolated IGT, for
isolated IFG 6-9% and for both IGT and IFG was 15-19%
CKD and early nephropathy
Neuropathies
Retinopathy
ASCVD (prediabetes or diabetes or IR)
Diabetes Res Clin Pract. 2007 Dec; 78(3):305-12.
Diabetes Care. 2000 Aug; 23(8):1113-8.
Diabetes Care. 2010 Oct; 33(10):2285-93.
Diabet Med. 2007 Feb; 24(2):137-44.
Lancet. 2010 Jun 26; 375(9733):2215-22.
World J Diabetes. 2015 Mar 15; 6(2): 296–303.

65. Goals of
therapy in
persons with
prediabetes
and metabolic
syndrome
• Prevent progression to T2DM
• Prevent progression to MAFLD
• Improve CVD risk factors via aggressive
control of:
elevated BP
dyslipidemia
• Treat ABCD
• Improve functionality and
• QoL

66. What are the
interventions?

67. Lifestyle intervention for the Prevention or Delay of
Type 2 Diabetes
67
Study Title (country of
conduct, year of
publication, n)
Risk eligibility criteria
Duration of
follow-up
Intervention
Risk reduction in diabetes
incidence compared to
control
Da Qing Study
(China, 1997, n=577) IGT; age ≥ 25 years
6 y Diet 31%
Exercise 46%
Diet + Exercise 42%
Control --
Finnish Diabetes Study
(Finland, 2001, n=522)
IGT; age 40–65 years; BMI > 25
kg/m2
3.2 y Diet + Activity 58%
Control --
Diabetes Prevention
Program
(US, 2002, n=3,234)
GT; FPG 5.3–6.9 mmol/l (<6.9
mmol/l for Native
American ancestry); age ≥ 25
years; BMI ≥ 24 kg/m2 (≥
22 kg/m2 in Asians)
2.8 y ILS 58%
Met 850 bid 31%
Placebo --
Japanese IGT Study
(Japan, 2005, n=458)
Men with IGT
4 y Diet + Exercise 67%
Control --
Indian Diabetes
Prevention Program
(India, 2006, n=531)
IGT; age 35–55 years
30 months Lifestyle 29%
Met 250 bid 26%
LS + Met 28%
Control --
Diabetologia
.
2017
September
;
60(9):
1601–1611.

68. Metformin for the Prevention or Delay of Type 2
Diabetes
68
Study Title (country of
conduct, year of
publication, n)
Risk eligibility criteria
Duration of
follow-up
Intervention
Risk reduction in
diabetes incidence
compared to control
Diabetes Prevention
Program
(US, 2002, n=3,234)
GT; FPG 5.3–6.9 mmol/l (<6.9
mmol/l for Native
American ancestry); age ≥ 25
years; BMI ≥ 24 kg/m2 (≥
22 kg/m2 in Asians)
2.8 y ILS 58%
Met 850 bid 31%
Placebo --
Indian Diabetes
Prevention Program
(India, 2006, n=531)
IGT; age 35–55 years
30 months Lifestyle 29%
Met 250 bid 26%
LS + Met 28%
Control --
Diabetologia. 2017 September ; 60(9): 1601–1611.

69. DPP and DPPOS
https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp

70. Role in PreDiabetes
Diabetes Prevention Program
Metformin reduced the incidence of T2DM by
31% relative to Placebo(13)
31% RRR
58% RRR
Ref. The writing group (William C. Knowler, M.D., Dr.P.H., Elizabeth Barrett- Connor, M.D., Sarah E. Fowler, Ph.D., Richard F. Hamman, M.D., Dr.P.H., John M. Lachin, Sc.D., Elizabeth A. Walker, D.N.Sc., and David M. Nathan, M.D.) takes
responsibility for the content of this article. Address reprint requests to he Diabetes Prevention Program Coordinating
Center, Biostatistics Center, George Washington University, 6110 Executive
Blvd., Suite 750, Rockville, MD 20852. *The members of the Diabetes Prevention Program Research Group are listed in the Appendix.

71. Cumulative incidence of diabetes and weight
change Since Randomization of DPP/DPPOS
71

72. Essential Role in Pre-Diabetes
Diabetes Prevention Program
Effect of Metformin was higher in
Younger age groups Higher BMI Higher FPG at baseline
Ref. Lancet Diabetes Endocrinol 2015;
3: 866–75
Published Online
September 14, 2015
http://dx.doi.org/10.1016/
S2213-8587(15)00291-0
See Comment page 831
*Members listed in the appendix
Correspondence to:
Prof David M Nathan, Diabetes
Prevention Program
Coordinating Center,
Biostatistics Center, George
Washington University,
6110 Executive Blvd, Suite 750,
Rockville, MD 20852, USA
dppmail@bsc.gwu.edu

73. At 15-year follow-up (DPPOS)
73
Participants with higher
FPG (>110 mg/dL) and
women with history of
GDM experienced high
RRR with metformin
Therefor, women with
prior GDM are
candidates for
metformin in diabetes
prevention

74. Reflected on
Metformin
Recommendation
in predaibetes

75. Compared to the placebo
intervention
The lifestyle
intervention cost
~$1,700 more per
person over 10 years
but substantially
improved quality-of-
life = “cost-effective”
The metformin
intervention cost
~$100 less per
person over 10 years
and marginally
improved quality-of-
life = “cost-saving”
Diabetes Care 2012;35:723-30

76. Intensive lifestyle was
intensive
• Individual lifestyle coaches and access to
support staff:
1. Dietitian
2. Behavioral counselor
3. Exercise specialist
• 16-session individual curriculum, covering
nutrition, exercise, and behavioral self
management
• Kept food journals (mandatory requirement in
run-in period); these were monitored
• The “Toolbox”

77. Consider
Prediabetes
treatment
• Prediabetes is a metabolic and vascular disorder,
and clinicians should actively treat people with
prediabetes in order to prevent or at least delay
progression to T2D and development of CVD
complications. Grade A; BEL 1

78. AACE endorses the healthy lifestyle
while dealing with prediabetes
• The prevention of T2D can be addressed by
lifestyle modifications that include a healthy meal
plan, regular physical activity, and behavioral
health practices and weight loss in persons with
ABCD. The Mediterranean diet should be
considered to reduce progression to T2D and risk
of CVD. Low-fat, vegetarian, and DASH meal
patterns can also be considered for prevention of
T2D. (Grade A, BEL 1)

79. AACE endorses the healthy lifestyle
while dealing with prediabetes
• Lifestyle intervention should include aerobic
and resistance physical activity in all persons
with prediabetes and/or metabolic syndrome.
The initial aerobic prescription may require a
progressive increase in the volume and
intensity of exercise, and the ultimate goal
should be 150 minutes/week of moderate
exercise performed during 3 to 5 sessions per
week (Grade A; BEL 1). Resistance exercise
should consist of single-set exercises that use
the major muscle groups 2 to 3 times per
week (Grade A; BEL 1). An increase in non-
exercise and active leisure activity should be
encouraged to reduce sedentary behavior
(Grade B; BEL 2).

80. AACE drugs for prediabetes
• Obesity medications, namely phentermine/topiramate ER, liraglutide 3 mg, or
weekly semaglutide 2.4 mg, in conjunction with lifestyle therapy, should be
considered in persons with prediabetes and/or metabolic syndrome with ABCD,
whether overweight (BMI 27 to 29.9 kg/m2) or with obesity (BMI ≥30 kg/m2),
when needed to achieve and sustain 7% to 10% weight loss for prevention of T2D.
(Grade A; BEL 1)
• Although no medications have been approved for the treatment of prediabetes,
diabetes medications including metformin, acarbose, pioglitazone, or GLP-1 RA
can be considered in persons with prediabetes or in persons who also have ABCD
and remain glucose-intolerant following weight loss using lifestyle and/or weight-
loss medications. (Grade A; BEL 1)

82. • Monitor for the development of type
2 diabetes in those with prediabetes
at least annually; modify based on
individual risk/benefit assessment. E
• Refer adults with overweight/obesity
at high risk of type 2 diabetes, as
typified by the DPP, to an intensive
lifestyle behavior change program to
achieve and maintain a weight
reduction of at least 7% of initial
body weight through healthy
reduced-calorie diet and ≥150
min/week of moderate intensity
physical activity. A
• A variety of eating patterns can be
considered to prevent diabetes in
individuals with prediabetes. B
82

83. • Prediabetes is associated with heightened
cardiovascular risk; therefore, screening for
and treatment of modifiable risk factors for
cardiovascular disease are suggested. B
• Statin therapy may increase the risk of type
2 diabetes in people at high risk of
developing type 2 diabetes. In such
individuals, glucose status should be
monitored regularly, and diabetes
prevention approaches reinforced. It is not
recommended that statins be discontinued.
B
• In people with a history of stroke and
evidence of insulin resistance and
prediabetes, pioglitazone may be
considered to lower the risk of stroke or
myocardial infarction. However, this benefit
needs to be balanced with the increased
risk of weight gain, edema, and fracture. A
Lower doses may mitigate the risk of

84. Prediabetes as A Continuum in DCRM

85. Diabetes
Prevention
Bottom-line
should actively treat people with prediabetes
= delay diabetes + delay complications
DPP intensive lifestyle
DPP metformin
Consider medication to treat ABCD +
prediabetes
Pioglitazone has its position in diabetes
prevention

86. Thank You