Main topics: Definitions.

Magnitude of Type 2 diabetes.

Factors associated with Type 2 diabetes.

Levels of prevention.

Types of interventions.

Barriers and obstacles.

Components of prevention programs.

Central issues in Type 2 diabetes prevention.

Type 2 Diabetes definition

It is the most common form of diabetes, characterized by disorders of insulin

resistance and insulin secretion, either of which may be the predominant feature. Both

are usually present at the time that the diabetes is clinically manifest.

2hr post glucose load venous plasma glucose mmol/l).11.1 >concentration (

Impaired glucose tolerance (IGT) definition

An intermediate category between normal glucose tolerance and unequivocal

diabetes. It describes an abnormality of glucose regulation.

2hr post glucose load venous plasma glucose concentration (7.8 - < 11.1 mmol/l).

Prevention Strategies

Strategy: A set of essential preventive measures believed sufficient to control a health problem.

The word prevention embodies the goals of medicine: to promote health, to preserve health, to restore health when it is impaired, and to minimize

suffering and distress. source: Last M, 1995: Dictionary of epidemiology.

Preventive strategies: approaches in the design

A population-based strategy, involving altering the lifestyle and environmental determinants

of Type 2 diabetes.

A high-risk strategy applying preventive measures on individuals identified as high-risk

for Type 2 diabetes.

Magnitude of the Problem

0

50

100

150

200

250

300

millions

1995

2000

2025

The number of people with

diabetes will nearly double within the

first quarter of this millennium.

World Health Report, 1997;

Geneva: WHO.

Developed Vs Developing

Region 2000 2025

Developed countries

6.2%

54.8 million

7.6%

72.2 million

Developing countries

3.5%

99.6 million

4.9%

227.7 million

King et al, Diabetes Care 1998; 21: 1414-31

Why is the prevalence of Type 2 diabetes increasing?

Aging of the population.

Increased incidence due to urbanization especially in the developing countries.

More sedentary lifestyle.

Food consumption patterns, more foods with high fat content and more refined

carbohydrates.

Factors associated with Type 2 diabetes

Non Modifiable

1- Genetic factors.

2- Demographic determinants:

such as age and ethnicity.

Modifiable

1- Behavioral and lifestyle-related: such

as obesity and physical inactivity.

2- Metabolic and intermediate risk

categories: such as IGT, IFG and GDM.

Why should we prevent diabetes?

To reduce human suffering.

To alleviate the economic burden.

To prevent morbidity and mortality from diabetes-related CVD.

Levels of prevention in Type 2 diabetes

Primary: Includes activities aimed at preventing diabetes from occurring in susceptible

populations or individuals.

Secondary: Early diagnosis and effective control of diabetes in order to avoid or at least delay the

progress of the disease.

Tertiary: Includes measures taken to prevent complications and disabilities due to diabetes.

Why the primary prevention?

“There is an urgent need to take the prevention of cardiovascular disease more seriously. The only sensible strategy is the population approach to

primary prevention.” Beaglehole, the Lancet 2001; 358: 661-3

Metabolic syndrome prevention

The main components of the metabolic syndrome are: glucose intolerance (diabetes or IGT), obesity, hypertension and dyslipidemia.

All of those components are risk factors for CVD and can be targeted in life style

interventions to prevent Type 2 diabetes.

Primary prevention Most of the results on prevention come from

studies on high risk groups rather than populations.

Studies have shown that people with IGT has a 2-7 fold higher risk of progression to Type 2 diabetes than persons with normal glucose

tolerance.

Among the factors that predicted progression were obesity, elevated fasting and 2-h blood glucose and fasting insulin concentrations.

Types of interventions Behavioral interventions: including changing

diet and increasing physical activity.

And/or

Pharmacological interventions: utilizing pharmaceutical agents to improve glucose

tolerance and insulin sensitivity.

Behavioral interventions

Several studies has shown that diet and physical activity reduced the incidence of Type 2 diabetes.

Example: The Swedish Malmo study showed that diet and exercise for 5 years in men with IGT reduced the

incidence of Type 2 diabetes by 50%. Eriksson et al, Diabetologia 1991; 34: 891-8

Examples

The DaQing Chinese study showed that over 6 years there were significant and similar reductions in the incidence of diabetes in subjects with IGT who were

randomized to diet, exercise, or combined diet-exercise treatment groups.

Pan et al, Diabetes Care, 1997; 20: 537-44