 In just one decade, the number of people with diabetes has more than doubled. According to the Centers for Disease Control and Prevention by 2050, one out of every three of us may have diabetes. What's the big deal? Well, the consequences of diabetes are legion. The number one cause of Adelon said blindness. The number one cause of kidney failure. The number one cause of surgical amputations. What can we do to prevent it? Well, the onset of type 2 diabetes is gradual, with most individuals progressing through a state of pre-diabetes, a condition now striking approximately one in three Americans. But only about one in ten even knows it. Since current methods of treating diabetes remain inadequate, prevention is preferable, but what works better? Lifestyle changes or drugs? We didn't know until this landmark study was published at the New England Journal of Medicine. Thousands were randomized to get a good double dose of the leading anti-diabetes drug or diet and exercise. The drug, metformin, is probably the safest diabetes drug there is. It does cause diarrhea, and about half of those who take it makes one in four nauseous, about one in ten suffer from asthenia, from the Greek meaning lack of strength, causing physical weakness and fatigue. But the risk of being killed by the drug is only about one in 66,000 every year. And the drug worked. Compared to placebo, in terms of the percentage of people developing diabetes within the four-year study period, fewer people in the drug group developed diabetes. But diet and exercise alone worked better. The lifestyle intervention reduced diabetes incidence by 58%, compared to only 31% with the drug. The lifestyle intervention was significantly more effective than the drug, and had fewer side effects. More than three-quarters of those on the drug reported gastrointestinal symptoms, though there was more muscle soreness reported in the lifestyle group on account they were actually exercising. Other studies subsequently found the same result. Non-drug approaches, superior to drug-based approaches for diabetes prevention. And the 50% or so drop in risk was not for people that actually improved their diet and lifestyle, but just those instructed to improve their diet and lifestyle, whether or not they actually did it. Check this out. This is one of the most famous diabetes prevention studies. 500 people with pre-diabetes randomized into a lifestyle intervention or control group, and during the trial, the risk of diabetes was reduced by that same 50% to 60%. But only a fraction of the patients met the modest goals. Even in the lifestyle intervention group, only about a quarter were able to eat enough fiber, meaning whole-plant foods, and cut down on enough saturated fat, which in this country is mostly dairy, dessert, chicken, and pork. They did better than the control group, and fewer of them developed diabetes because of it. But what if you looked just at the folks that actually made the lifestyle changes, met at least four out of five of those wimpy goals? They had zero diabetes. None of them got diabetes, 100% drop in risk. Bottom line, type 2 diabetes can be prevented by changes in lifestyle, even in high-risk pre-diabetic subjects. The fact then that type 2 diabetes, a largely preventable disorder, has reached such epidemic proportion is a public health humiliation.