Abstract
The DECODE (Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe) study provides a clear overview of the outcomes of metabolic syndrome and type 2 diabetes in terms of cardiovascular mortality in a European population. The study demonstrates that the presence of the metabolic syndrome doubles the risk of cardiovascular mortality, with a stronger effect in women than in men.1 Although each individual component of the metabolic syndrome confers an increased risk of cardiovascular mortality, this is not as pronounced as when the metabolic syndrome itself is present. The more the components of the metabolic syndrome, the higher cardiovascular mortality.1 In addition, DECODE also demonstrates that the combination of metabolic syndrome and type 2 diabetes leads to a significantly increased risk of cardiovascular or all-cause mortality, with this risk again being higher in women ( Table 1 ). Life expectancy for people with type 2 diabetes is decreased by 5–10 years and adults with diabetes have an annual mortality of about 5.4%, which is double the rate for non-diabetic adults.2,3 View this table: Table 1 Relative risk for mortality in subjects with either metabolic syndrome, or diabetes, or both1 The often devastating impact of these conditions has led to much interest in how outcomes for people with type 2 diabetes can be improved and how type 2 diabetes can be prevented in the first place. ### Lifestyle interventions A number of studies have now demonstrated the efficacy of specific, goal-oriented lifestyle interventions in the prevention of type 2 diabetes. This is clearly demonstrated by the Finnish Diabetes Prevention Study (DPS),4 in which 522 middle-aged, overweight subjects with impaired glucose tolerance (IGT)5 were randomly assigned to either the intervention group or the control group. Each subject in the intervention group received individualized counselling6 aimed at reducing weight and intake of total and …
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