A strategic approach to diabetes prevention: how much evidence is required before we act?

Abstract

1 ISSN 1758-1907 10.2217/DMT.12.79 © 2013 Future Medicine Ltd Diabetes Manage. (2013) 3(1), 1–4 The global diabetes epidemic continues unabated with the number of people with diabetes predicted to increase from 366 million in 2011 to 552 million by 2030 [1]. In Australia, the burden of Type 2 diabetes is increasing and diabetes is expected to become the leading cause of disease burden by 2023 [2]. It is now just over a decade since the landmark US Diabetes Prevention Program (USDPP) and Finnish Diabetes Prevention Study both found that the risk of developing Type 2 diabetes could be reduced by 58% by lifestyle modification that focused on nutrition, physical activity and modest weight loss, and, more recently, that it could be sustained [3,4]. Cost–effectiveness analyses of different strategies for screening and prevention of Type 2 diabetes suggest that screening for Type 2 diabetes and impaired glucose tolerance, followed by interventions, is cost effective [5]. Furthermore, in the USDPP, lifestyle intervention was more cost effective than pharmacological intervention [6]. The potential to prevent or delay Type 2 diabetes in high-risk individuals by lifestyle intervention has been unequivocally established (proof of concept); however, most landmark studies, conducted exclusively in primary care settings, used intensive, individualized interventions that would be difficult to roll out as population-wide programs [7]. The challenge is to translate this evidence into feasible and effective communitybased programs that can be scaled up and rolled out more broadly in existing health and community systems [8,9]. In response to the challenge, a promising range of translational research studies have emerged over the past decade. In addition to the primary care setting, several studies have demonstrated the feasibility of screening and recruiting in workplaces and community settings, together with the effectiveness of group-based interventions [10–12]. Moving from scientific discovery to population-wide implementation requires a series of steps, each building upon the achievements of the previous step, from basic research to diffusion of interventions [13]. Over the last decade the USA, Finland and other parts of Europe have been leading the way in exploring policy efficiency, availability and distribution, as well as diffusion of diabetes interventions. In these countries, governments are showing