Primary Prevention of Type 2 Diabetes and Cardiometabolic-Based Chronic Disease Using Lifestyle Medicine

Dysglycemia is a key mechanistic metabolic driver of cardiometabolic-based chronic diseases. The epidemic of type 2 diabetes (T2D; dysglycemia-based chronic disease [DBCD] stage 3) can be partly attributed to environmental factors including sedentary lifestyle and changes in dietary trends. Individuals with prediabetes (DBCD stage 2) have a high risk of conversion to T2D, and primary prevention strategies to mitigate or abrogate DBCD stage 2 progression to stage 3 are vital. There is mounting evidence that dietary patterns including the Dietary Approaches to Stop Hypertension and Mediterranean diets can postpone the development of T2D and have positive cardiometabolic outcomes. Although these diets differ in their exact composition, they have several common features including an emphasis on the intake of whole grains, fruits, vegetables, nuts, legumes with reduced intake of red and processed meats, processed grains, sugar, and sweetened beverages. Physical activity leads to an increase in insulin sensitivity and glucose disposal. Acute exercise increases the abundance of glucose transporter 4 (GLUT4), leading to an increase in glucose uptake by skeletal muscles along with GLUT4 translocation via an insulin-independent pathway. Chronic training improves insulin sensitivity through different mechanisms, including improved skeletal muscle responses to insulin via increased expression and activity of proteins involved in insulin signaling. Clinical trials, such as the Diabetes Prevention Program and Finnish Diabetes Prevention Study, have demonstrated a significant risk reduction in the incidence of T2D in high-risk individuals via changes in lifestyle with the use of personalized and individualized counseling with frequent follow-up encounters by skilled professionals. Primary prevention of disease is critical, exemplified by the mitigation/abrogation of DBCD stage 2 progression to DBCD stage 3, especially in the context of lowering the risk for diabetic complications and cardiovascular diseases.