Does diabetes prevention translate into reduced long-term vascular complications of diabetes?
Open accessAbstract
The global epidemic of type 2 diabetes has prompted numerous studies and public health efforts to reduce its development. A variety of interventions, including lifestyle modifications and pharmacological agents directed at ameliorating the major risk factors for type 2 diabetes, are of proven efficacy in reducing the development of type 2 diabetes in people with impaired glucose tolerance. While prevention of the hyperglycaemia characteristic of diabetes is arguably an important, clinically relevant outcome, a more compelling outcome with greater clinical significance is the prevention or reduction of the relatively diabetes-specific microvascular and less-specific cardiovascular disease (CVD) complications associated with diabetes. These complications cause the majority of morbidity and excess mortality associated with diabetes. Any reduction in diabetes should, logically, also reduce the occurrence of its long-term complications; however, most diabetes prevention trials have not been of sufficient duration to allow such an evaluation. The limited long-term data, largely from the Da Qing Diabetes Prevention Study (DQDPS) and the Diabetes Prevention Program (DPP) and their respective follow-up studies (DQDPOS and DPPOS), suggest a reduction in microvascular complications and amelioration of CVD risk factors. Only the DQDPOS and Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP-NIDDM) studies have shown a reduction in CVD events and only DQDPOS has demonstrated a decrease in CVD and overall mortality. While these limited data are promising, whether diabetes prevention directly reduces complication-related morbidity and mortality remains unclear. Longer follow-up of prevention studies is needed to supplement the limited current clinical trial data, to help differentiate the effects of diabetes prevention itself from the means used to reduce diabetes development and to understand the balance among benefits, risks and costs of prevention.
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The evidence that population screening for hyperglycemia and subsequent prevention efforts will provide long-term benefit is inconsistent.
“Notwithstanding this recommendation, the evidence that population screening for hyperglycemia and subsequent prevention efforts will provide long-term benefit is inconsistent (27).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [27]
The Discussion (page unavailable) says evidence that diabetes prevention reduces long-term vascular complications is inconsistent. The paper assesses prevention studies, not population screening for hyperglycemia followed by prevention efforts, so it does not establish the claim for that broader strategy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn the most recent NIH DPPOS report, prevention of progression from prediabetes to diabetes resulted in lower rates of developing retinopathy and nephropathy.
“In the most recent National Institutes of Health (NIH) Diabetes Prevention Program Outcomes Study (DPPOS) report, prevention of progression from prediabetes to diabetes (98) resulted in lower rates of developing retinopathy and nephropathy (99).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [99]
The DPPOS section reports 28% lower prevalence of a composite microvascular outcome among participants who did not develop diabetes than among those who did, regardless of treatment assignment. That composite included retinopathy and nephropathy, but the paper does not establish lower rates for each separately or that preventing diabetes caused those reductions. It also reports no significant difference in these outcomes among the three intervention groups after 15 years. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn the DPPOS report, prevention of progression from prediabetes to diabetes resulted in lower rates of developing retinopathy and nephropathy.
“In the National Institutes of Health (NIH) Diabetes Prevention Program Outcomes Study (DPPOS) report, prevention of progression from prediabetes to diabetes (101) resulted in lower rates of developing retinopathy and nephropathy (102).”
From 2. Diagnosis and classification of diabetes: standards of care in diabetes-2025 (2025) · cites this paper as [102]
The DPPOS microvascular-complications section reports 28% lower prevalence of a composite outcome among participants who did not develop diabetes; the composite included retinopathy, nephropathy and neuropathy. It does not establish lower rates of developing retinopathy and nephropathy separately, nor that preventing diabetes caused those reductions. The same section reports no significant difference in these outcomes among the three intervention groups after a mean 15 years. (LLM, conf=0.88)
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References 47 · Cited by 91
- Authors
- and the DPP Research Group, Nathan, D. M., Bennett, P. H., Crandall, J. P., Edelstein, S. L., Goldberg, R. B., Kahn, S. E., Knowler, W. C., Mather, K. J., Mudaliar, S., Orchard, T. J., Temprosa, M., & White, N. H.
- Affiliations
- Harvard University (US)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Albert Einstein College of Medicine (US)
- George Washington University (US)
- University of Miami (US)
- University of Washington (US)
- Indiana University School of Medicine (US)
- UC San Diego Health System (US)
- University of Pittsburgh (US)
- Washington University in St. Louis (US)
- Corresponding author
- Nathan, David M.
- ORCID
- Venue
- Diabetologia
- Published
- 2019-07-04
- Volume
- 62
- Issue
- 8
- Pages
- 1319-1328
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC6818092
- OpenAlex
- W2956084250
- Cited by
- 91
- References
- 47
- Citations by year
- 2026: 5 · 2025: 16 · 2024: 16 · 2023: 13 · 2022: 14 · 2021: 13 · 2020: 6 · 2019: 8
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR002556, UL1TR002345)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK048339, U01DK048375, U01DK048397, U01DK048406, U01DK048413, R01DK078907, U01DK048485, U01DK048400, U01DK048434, U01DK048412, U01DK048377, U01DK048437, U01DK048514, U01DK048489, U01DK048468, U01DK048407, U01DK048381, U01DK048443, U01DK048349, U01DK048404, P30DK017047, P30DK111022)
- National Center for Research Resources (M01RR016587)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes prevention, diabetes complications, microvascular complications, cardiovascular disease, impaired glucose tolerance, Diabetes Prevention Program, long-term follow-up, mortality, lifestyle intervention, pharmacological prophylaxis
- MeSH terms
- Rosiglitazone, Cardiovascular Diseases, Clinical Trials as Topic, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Follow-Up Studies, Humans, Hypoglycemic Agents, Life Style, Metformin, Microcirculation, Preventive Medicine, Risk Factors, Treatment Outcome, Ramipril, Glucose Intolerance, Diabetes Complications, Atherosclerosis
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