As not all T2DM high-risk individuals are able to adhere to lifestyle changes and achieve the desired results, other interventions are needed including pharmacological therapy (Odegard
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& Capoccia, 2007). The DPP demonstrated that metformin twice daily with meals reduced the incidence of T2DM by 31% compared with the placebo. The IDPP group found similar benefit in both metformin and lifestyle modification groups (28%) with no added benefit when combining them together. In contrast to DPP, IDPP shows a benefit with metformin in those with BMI well below 30kg/m2. The IDF also recommends that when lifestyle intervention has not achieved the desired weight-loss or improved IGT goals, metformin should be considered as a T2DM prevention strategy (Alberti, Zimmet & Shaw, 2007). However metformin is not recommended for everyone with IGT as there are standard contraindications, it may affect and be linked with lactic acidosis (renal, hepatic and ischaemic disorders) and it may be less effective in terms of prevention in those aged 60years or over. Pharmacological intervention is therefore predominantly recommended as a secondary intervention to use in conjunction with lifestyle interventions (Odegard & Capoccia, 2007).
As mentioned previously, genetics play a major role in the development of T2DM, even though it is unclear which genetic material is responsible for this. Siitonen and colleagues’ (2004) research indicates that the 12Glu9 polymorphism in ADRA2B is associated with impaired beta cell function. This genetic polymorphism may predispose an individual to T2DM. They also found that insulin secretion does not work with Glu9 allele in participants with IGT, which increases the risk of T2DM especially in individuals who are not exposed to a lifestyle intervention. Lifestyle also affects the genetic makeup of an individual which in return affects their risk of T2DM. Corpeleijn and colleagues (2006) report that there is increasing evidence that serum fatty acid profiles and fatty acid desaturase activities are potentially influenced by lifestyle factors i.e. diet and exercise. They believe a lifestyle intervention programme improves glucose tolerance and insulin sensitivity in individuals without T2DM diagnosis, thus reducing the risk of T2DM.
Implementing psychological therapy as part of a prevention intervention may be useful. Research on coping styles has shown that acceptance of T2DM and diabetes-related cognitions are significantly related to HbA1C values, and negative thoughts and feelings are
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associated with higher levels of depression, poorer quality of life, and lower adherence to medication (Gregg, Callaghan & Hayes et al., 2007; Weijman, Ros, & Rutten, 2005). Gregg and colleagues reported that their traditional diabetes education workshop was associated with improved reported self-management by participants but no improvements in actual diabetic control thus supporting the importance of an acceptance, mindfulness, and values- based approach to helping individuals develop the psychological resources to manage their diabetes. There is growing evidence that acceptance-based coping is associated with less distress, and passive coping is less effective than active coping strategies (Classen, Butler & Koopman et al., 2001, Gregg et al., 2007).
Motivational interviewing is another example of a psychological tool. It was originally used to treat addictive behaviours, for example the stop smoking services across the UK use motivational interviewing for smoking cessation purposes to help encourage smokers to quit. However they also use other strategies to help quitters cope with withdrawal effects as well as motivational interviewing. Motivational interviewing is now being used to enhance health behaviours including diet and exercise (Carels, Darby & Cacciapaglia et al., 2007). Carels and colleagues found that motivational interviewing increases motivation for change resulting in more positive behaviour which can help individuals who are struggling to lose weight. Participants who received motivational interviewing lost significantly more weight and exercised significantly more than comparable behavioural weight-loss programme participants. However it is the recommendation of this review for counselling not to be the sole element of a T2DM prevention intervention.
Previously the aim was to improve the knowledge and skills of individuals regarding T2DM but this approach has not been very successful in reducing obesity and increasing physical activity levels (Venmans, Gorter & Baard et al., 2007). Therefore it is more useful to focus on the environment and conditions that are helpful to achieving and maintaining an active lifestyle and healthy eating habits by focusing on engaging and interacting with participants. There is encouraging research regarding the efficacy of Internet-based weight-loss
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interventions (Aaron, Dearwater & Anderson et al., 1995) however in this review Glasgow et al.’s study (2007) did not yield significant results with reference to T2DM prevention. The Internet can be a very powerful resource to use in providing effective information and interaction with a variety of population groups including the hard-to-reach and extroverted groups. It is a non-invasive and user-friendly tool which would allow individuals to gain support and advice from others going through the same thing they are. They could also use it to contact health professionals with any concerns. However the appeal and applicability of ehealth in real-world settings is still questionable (Koo & Skinner, 2005; Brandenburg, Bauer & Reusch et al., 1999). The downside to using the internet is that it is so vast that a new user could find it very challenging and a deterrent. However in today’s society most individuals are computer literate or at least have a basic understanding on how to use the Internet therefore it would be a good resource to use in a prevention programme.