4. Prevention or Delay of Type 2 Diabetes.

Recommendations c Patients with prediabetes should be referred to an intensive diet and physical activity behavioral counseling program adhering to the tenets of the Diabetes Prevention Program (DPP) targeting a loss of 7% of body weight and should increase their moderate-intensity physical activity (such as brisk walking) to at least 150 min/week. A c Follow-up counseling and maintenance programs should be offered for longterm success in preventing diabetes. B c Based on the cost-effectiveness of diabetes prevention, such programs should be covered by third-party payers. B c Metformin therapy for prevention of type 2 diabetes should be considered in those with prediabetes, especially in those with BMI .35 kg/m, those aged ,60 years, and women with prior gestational diabetes mellitus. A c At least annual monitoring for the development of diabetes in those with prediabetes is suggested. E c Screening for and treatment of modifiable risk factors for cardiovascular disease is suggested. B c Diabetes self-management education and support programs are appropriate venues for people with prediabetes to receive education and support to develop andmaintain behaviors that can prevent or delay the onset of diabetes. B c Technology-assisted tools including Internet-based social networks, distance learning, DVD-based content, and mobile applications can be useful elements of effective lifestyle modification to prevent diabetes. B