Download PDF
Exp Clin Endocrinol Diabetes 2008; 116(3): 167-172
DOI: 10.1055/s-2007-992115
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

The European Perspective of Type 2 Diabetes Prevention: Diabetes in Europe - Prevention Using Lifestyle, Physical Activity and Nutritional Intervention (DE-PLAN) Project

P. E. H. Schwarz 1 , J. Lindström 2 , 3 , K. Kissimova-Scarbeck 4 , Z. Szybinski 6 , N. C. Barengo 2 , M. Peltonen 3 , J. Tuomilehto 2 , 5 ,  on behalf of the DE-PLAN project
  • 1Department of Medicine III, Medical Faculty Carl Gustav Carus of the Technical University Dresden, Dresden, Germany
  • 2Department of Public Health, University of Helsinki, Helsinki, Finland
  • 3Diabetes Unit, Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland
  • 4Department of Health Economics and Social Security, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
  • 5South Ostrobothnia Central Hospital, Seinäjoki, Finland
  • 6Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
Further Information

Publication History

received 27.09.2007 first decision 27.09.2007

accepted 27.09.2007

Publication Date:
19 March 2008 (online)

Also available at
    Permissions and Reprints

Abstract

Background: The prevalence of type 2 diabetes (T2D) has dramatically increased in Europe, and the age-at-diagnosis has become younger. Action is needed now to develop targeted prevention management program for T2D. The DE-PLAN (“Diabetes in Europe - Prevention using Lifestyle, Physical Activity and Nutritional intervention”) project, led by the University of Helsinki is currently addressing this major public health concern in Europe.

Methods: The DE-PLAN project aims at developing and testing models of efficient identification and intervention of individuals at high risk of type 2 diabetes in the community. It conducts a lifestyle modification intervention in people at high risk for T2D. Furthermore, it tests the feasibility and cost-effectiveness of the translation of the current research evidence about preventive intervention program into clinical settings within existing health care systems in 17 European countries.

Results: This 3-year project spanning has commenced mid-2005. By now, 25 institutions from 17 countries are involved.

Conclusion: The development of efficient screening strategies for type 2 diabetes risk as well as the development of core intervention strategies for the primary prevention of type 2 diabetes should significantly enhance the ability of health care professionals to respond swiftly to the drastic increase of T2D and its burden to the society.

Key words

type 2 diabetes - prevention - screening - FINDRISC - intervention program - quality standards - cost-effectiveness

References

  • 1 King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections.  Diabetes Care. 1998;  21 ((9)) 1414-1431
    CrossrefPubMedSearch in Google Scholar
  • 2 Schwarz PE. Congress report from the American Diabetes Association 66th Annual Scientific Sessions in Washington, USA.  Exp Clin Endocrinol Diabetes. 2006;  114 ((10)) 605-610
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Schwarz PE. Report from the Congress of the American Diabetes Association (ADA): Orlando 2005-65th Annual Scientific Sessions in San Diego, CA, USA, June 10th-14th 2005.  Exp Clin Endocrinol Diabetes. 2005;  113 ((8)) 475-479
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 The DECODE Study Group (Tuomilehto J) . Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts.  Diabetes Care. 2003;  26 ((1)) 61-69
    CrossrefPubMedSearch in Google Scholar
  • 5 Diabetes Atlas, ed. I.D. Federation . , Vol. 3. 2006;  , International Diabetes Federation
  • 6 Valensi P. et al . Pre-diabetes essential action: a European perspective.  Diabetes Metab. 2005;  31 ((6)) 606-620
    CrossrefPubMedSearch in Google Scholar
  • 7 Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic.  Nature. 2001;  414 ((6865)) 782-787
    CrossrefPubMedSearch in Google Scholar
  • 8 Kulzer B. Diabetes mellitus: how important is it to measure the quality of life?.  Dtsch Med Wochenschr. 2006;  131 ((Suppl 8)) S259-S263
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Glucose tolerance and mortality: comparison of WHO. American Diabetes Association diagnostic criteria. The DECODE study group . European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe.  Lancet. 1999;  354 ((9179)) 617-621
    CrossrefPubMedSearch in Google Scholar
  • 10 Lindgren P. et al . Lifestyle intervention to prevent diabetes in men and women with impaired glucose tolerance is cost-effective.  Int J Technol Assess Health Care. 2007;  23 ((2)) 177-183
    CrossrefPubMedSearch in Google Scholar
  • 11 Roglic G. et al . The burden of mortality attributable to diabetes: realistic estimates for the year 2000.  Diabetes Care. 2005;  28 ((9)) 2130-2135
    CrossrefPubMedSearch in Google Scholar
  • 12 Matthews DR, Pramming S. Diabetes and the global burden of non-communicable disease.  Lancet. 2003;  362 ((9397)) 1763-1764
    PubMedSearch in Google Scholar
  • 13 Trajkovski M. et al . Genes of type 2 diabetes in Beta cells.  Endocrinol Metab Clin North Am. 2006;  35 ((2)) 357-369
    CrossrefPubMedSearch in Google Scholar
  • 14 Schwarz PE. et al . Hypoadiponectinemia is associated with progression toward type 2 diabetes and genetic variation in the ADIPOQ gene promoter.  Diabetes Care. 2006;  29 ((7)) 1645-1650
    CrossrefPubMedSearch in Google Scholar
  • 15 Schwarz PE, Bornstein SR. Pre-diabetes and metabolic syndrome in Germans.  Horm Metab Res. 2006;  38 ((5)) 359
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Hanefeld M. et al . The metabolic syndrome-a postprandial disease?.  Horm Metab Res. 2006;  38 ((7)) 435-436
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Steyn NP. et al . Diet, nutrition and the prevention of type 2 diabetes.  Public Health Nutr. 2004;  7 ((1A)) 147-165
    CrossrefPubMedSearch in Google Scholar
  • 18 Lindstrom J, Peltonen M, Tuomilehto J. Lifestyle strategies for weight control: experience from the Finnish Diabetes Prevention Study.  Proc Nutr Soc. 2005;  64 ((1)) 81-88
    CrossrefPubMedSearch in Google Scholar
  • 19 Hu G. et al . Physical activity, physical fitness and the risk of type 2 diabetes.  Metabolic Syndrome Rel Disorders. 2005;  3 35-44
    PubMedSearch in Google Scholar
  • 20 Hanefeld M. et al . The challenge of the metabolic syndrome.  Horm Metab Res. 2007;  39 ((9)) 625-626
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Diamantopoulos EJ. et al . Metabolic syndrome and prediabetes identify overlapping but not identical populations.  Exp Clin Endocrinol Diabetes. 2006;  114 ((7)) 377-383
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Haffner SM. et al . Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.  N Engl J Med. 1998;  339 ((4)) 229-234
    CrossrefPubMedSearch in Google Scholar
  • 23 Miettinen H. et al . Impact of diabetes on mortality after the first myocardial infarction. The FINMONICA Myocardial Infarction Register Study Group.  Diabetes Care. 1998;  21 ((1)) 69-75
    PubMedSearch in Google Scholar
  • 24 Schwarz PE. et al . Diabetes prevention-from physiology to implementation.  Horm Metab Res. 2006;  38 ((7)) 460-464
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Ottelin AM. et al . Costs of a self-selected, health-promoting diet among the participants of the Finnish Diabetes Prevention Study.  Diabetes Care. 2007;  30 ((5)) 1275-1277
    CrossrefPubMedSearch in Google Scholar
  • 26 Knowler WC. et al . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.  N Engl J Med. 2002;  346 ((6)) 393-403
    CrossrefPubMedSearch in Google Scholar
  • 27 Tuomilehto J. et al . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.  N Engl J Med. 2001;  344 ((18)) 1343-1350
    CrossrefPubMedSearch in Google Scholar
  • 28 Chiasson JL. et al . Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial.  Lancet. 2002;  359 ((9323)) 2072-2077
    CrossrefPubMedSearch in Google Scholar
  • 29 Pan XR. et al . Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.  Diabetes Care. 1997;  20 ((4)) 537-544
    CrossrefPubMedSearch in Google Scholar
  • 30 Snitker S. et al . Changes in insulin sensitivity in response to troglitazone do not differ between subjects with and without the common, functional Pro12Ala peroxisome proliferator-activated receptor-gamma2 gene variant: results from the Troglitazone in Prevention of Diabetes (TRIPOD) study.  Diabetes Care. 2004;  27 ((6)) 1365-1368
    PubMedSearch in Google Scholar
  • 31 Torgerson JS. et al . XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients.  Diabetes Care. 2004;  27 ((1)) 155-161
    Search in Google Scholar
  • 32 Bosch J. et al . Effect of ramipril on the incidence of diabetes.  N Engl J Med. 2006;  355 ((15)) 1551-1562
    CrossrefPubMedSearch in Google Scholar
  • 33 Lindstrom J. et al . Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study.  Lancet. 2006;  368 ((9548)) 1673-1679
    CrossrefPubMedSearch in Google Scholar
  • 34 Zimmet P. The burden of type 2 diabetes: are we doing enough?.  Diabetes Metab. 2003;  29 ((4 Pt 2)) 6S9-618
    CrossrefPubMedSearch in Google Scholar
  • 35 Schwarz PE. et al . Development of a diabetes prevention management program for clinical practice.  Public Health Rep. 2007;  122 ((2)) 258-263
    CrossrefPubMedSearch in Google Scholar
  • 36 Hall M. et al . Diabetes- The Policy Puzzle: Towards Benchmaking in the EU 25.  International Diabetes Federation European Region and Federation of European Nurses in Diabetes. 2005;  103
    PubMedSearch in Google Scholar
  • 37 Saaristo T. et al . National type 2 diabetes prevention programme in Finland: FIN-D2D.  Int J Circumpolar Health. 2007;  66 ((2)) 101-112
    CrossrefPubMedSearch in Google Scholar
  • 38 Lindstrom J, Tuomilehto J. The Diabetes Risk Score: A practical tool to predict type 2 diabetes risk.  Diabetes Care. 2003;  26 ((3)) 725-731
    CrossrefPubMedSearch in Google Scholar
  • 39 Saaristo T. et al . Cross-sectional evaluation of the Finnish Diabetes Risk Score: a tool to identify undetected type 2 diabetes, abnormal glucose tolerance and metabolic syndrome.  Diab Vasc Dis Res. 2005;  2 ((2)) 67-72
    CrossrefPubMedSearch in Google Scholar
  • 40 Schwarz P. Targeted diabetes prevention in high risk groups: pro.  Dtsch Med Wochenschr. 2005;  130 ((17)) 1103
    Thieme ConnectPubMedSearch in Google Scholar
  • 41 Silventoinen K. et al . The validity of the Finnish Diabetes Risk Score for the prediction of the incidence of coronary heart disease and stroke, and total mortality.  Eur J Cardiovasc Prev Rehabil. 2005;  12 ((5)) 451-458
    CrossrefPubMedSearch in Google Scholar
  • 42 Schwarz PEH. et al . An accurate risk score based on anthropometric, dietary, and lifestyle factors to predict the development of type 2 diabetes, response to Schulze et al.  Diabetes Care. 2007;  30 ((8)) e87
    CrossrefPubMedSearch in Google Scholar
  • 43 Bergmann A. et al . A simplified finnish diabetes risk score to predict type 2 diabetes risk and disease evolution in a german population.  Horm Metab Res. 2007;  39 ((9)) 677-682
    Thieme ConnectPubMedSearch in Google Scholar
  • 44 Schwarz PE, Bornstein SR, Hanefeld M. Elevated fasting glucose levels predicts IGT and diabetes also in middle-age subjects.  Diabetes Res Clin Pract. 2007;  77 ((1)) 148-150
    CrossrefPubMedSearch in Google Scholar
  • 45 Mielck A, Reitmeir P, Rathmann W. Knowledge about diabetes and participation in diabetes training courses: the need for improving health care for diabetes patients with low SES.  Exp Clin Endocrinol Diabetes. 2006;  114 ((5)) 240-248
    Thieme ConnectPubMedSearch in Google Scholar
  • 46 Schwarz PEH. et al . Prevention of type 2 diabetes: what challenges do we have to address?.  Journal of Public Health. 2005;  13 ((2)) 303-308
    CrossrefPubMedSearch in Google Scholar
  • 47 Roubideaux Y. et al . Measuring the quality of diabetes care for older american indians and alaska natives.  Am J Public Health. 2004;  94 ((1)) 60-65
    PubMedSearch in Google Scholar
  • 48 Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes.  Diabetes Care. 2003;  26 ((9)) 2518-2523
    CrossrefPubMedSearch in Google Scholar
  • 49 Hernan WH. et al . Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program.  Diabetes Care. 2003;  26 ((1)) 36-47
    CrossrefPubMedSearch in Google Scholar
  • 50 Qiao Q, Tuomilehto J. Diagnostic criteria of glucose intolerance and mortality.  Minerva Med. 2001;  92 ((2)) 113-119
    PubMedSearch in Google Scholar
  • 51 Schwarz PE, Peltonen M. Prevention of type 2 diabetes - lessons we have learnt for implementation.  Horm Metab Res. 2007;  39 ((9)) 636-641
    Thieme ConnectPubMedSearch in Google Scholar

Correspondence

Dr. P. E. H. Schwarz

Department of Medicine III

Medical Faculty Carl-Gustav-Carus

Technical University Dresden

01307 Dresden

Germany

Phone: +49/351/458 27 15

Fax: +49/351/458 73 19

Email: peter.schwarz@uniklinikum-dresden.de