Preventing Diabetes

Abstract

Readers of Diabetes Care know that the prevalence and cost of diabetes is increasing rapidly. Without a suitable population health response, the epidemic of obesity coupled with an aging population will relentlessly increase that burden. Breakthroughs in management of diabetes and systematic delivery of effective clinical services may ameliorate the enormous cost of the disease, but that is not the solution. The real answer lies in preventing the disease in the first place. Until recently, we had few effective strategies for attacking the root of the problem over the longer term. Those now exist. We need to promote primary prevention strategies to improve nutrition and reduce sedentary behavior, but to do so will require a major societal commitment to safe, walkable communities; good recreational facilities; changes in agricultural subsidies and marketing of poor food choices; school nutrition education and physical activity programs; social supports; financial incentives for fitness; and much more. The Guide to Community Preventive Services has begun to assess the effectiveness of those interventions (1). While we await the implementation and impact of primary prevention strategies, there are concrete actions that clinicians could take now if the necessary financial and delivery systems were in place. The Diabetes Prevention Program (DPP) unequivocally demonstrated the potential for slowing the progression of glucose impairment to diabetes. Metformin was effective, but the behavioral interventions were almost twice as effective (2), and …