Abstract
One of the major challenges today is the development of prevention programs for the clinical practice. Our aim was to develop a concept for a primary diabetes prevention program to be implemented in general health care. Lifestyle intervention addressing diet and exercise has reduced the diabetes risk by up to 58%. Early preventive pharmacological strategies have yielded a diabetes risk reduction of 25-30%. These findings offer a compelling evidence base, but delivery of intervention and care is essential. The challenge therefore is the management of prevention and intervention programs considering scientific aspects and practical requirements during implementation. The Diabetes Prevention Workgroup at the German Diabetes Association has developed a concept for a decentralized prevention program. Based on the results of the prevention studies, the intervention concept consists of a three-step program including identification of the individuals at high risk to develop type 2 diabetes (1), followed by general intervention based on individual choice (2) and maintained continuous intervention for motivation maintenance (3). Structured prevention programs will enable nationwide prevention of diabetes mellitus without consuming large resources. This process will be challenging and time consuming, requiring many partners but resulting in a profitable “health” investment.
Key words
Prevention - type 2 diabetes - insulin resistance - TUMAINI
References
1
Zimmet P, Alberti KG, Shaw J.
Global and societal implications of the diabetes epidemic.
Nature.
2001;
414
782-787
2
Valensi P. et al. .
Pre-diabetes essential action: a European perspective.
Diabetes Metab.
2005;
31
606-620
3
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
229-234
4
Haffner SM.
Can reducing peaks prevent type 2 diabetes: implication from recent diabetes prevention trials.
Int J Clin Pract Suppl.
2002;
129
33-39
5
Liebl A. et al. .
Costly type 2 diabetes mellitus. Does diabetes cost 20 billion per year?.
MMW Fortschr Med.
2000;
142
39-42
6
Knowler WC. et al. .
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
N Engl J Med;.
2002;
346
393-403
7
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
1343-1350
8
Chiasson JL. et al. .
Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial.
Lancet.
2002;
359
2072-2077
9
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
537-544
10
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
1365-1368
11
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
155-161
12
Ramachandran A. et al. .
The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1).
Diabetologia.
2006;
49
289-297
13
Stumvoll M, Goldstein BJ, van Haeften TW.
Type 2 diabetes: principles of pathogenesis and therapy.
Lancet.
2005;
365
1333-1346
14
Schwarz P. et al. .
Prevention of type 2 diabetes: what challenges do we have to address.
Journal of Public Health.
2005;
2
296-303
15
Azen SP. et al. .
TRIPOD (TRoglitazone In the Prevention Of Diabetes): a randomized, placebo-controlled trial of troglitazone in women with prior gestational diabetes mellitus.
Control Clin Trials.
1998;
19
217-231
16
Sartorelli DS. et al. .
Primary prevention of type 2 diabetes through nutritional counseling.
Diabetes Care.
2004;
27
3019
17
Zimmet P, Shaw J, Alberti KG.
Preventing Type 2 diabetes and the dysmetabolic syndrome in the real world: a realistic view.
Diabet Med.
2003;
20
693-702
18
Schwarz P. et al. .
Gründung der “Arbeitsgemeinschaft Prävention des Typ-2-Diabetes” der DDG.
Diabetes und Stoffwechsel.
2003;
12
296-274
19
Schwarz P.
Targeted diabetes prevention in high risk groups: pro.
Dtsch Med Wochenschr.
2005;
130
1103
20
Wenying Y, Lixiang L, Jinwu Q, Zhiqing Y, Haicheng P, Guofeng H.
The preventive effect of acanbose and metformin on the IGT population from becoming diabetes mellitus - a 3-year multicenter prospective study.
Chin J Endocrinol Metab.
2001;
17
131-136
21
Chiasson JL. et al. .
The STOP-NIDDM Trial: an international study on the efficacy of an alpha-glucosidase inhibitor to prevent type 2 diabetes in a population with impaired glucose tolerance: rationale, design, and preliminary screening data. Study to Prevent Non-Insulin-Dependent Diabetes Mellitus.
Diabetes Care.
1998;
21
1720-1725
Correspondence
Dr. med. Peter Schwarz
Technical University Dresden·Medical Faculty Carl Gustav Carus·MedicalClinic III·Department of Endocrinopathies and Metabolic Disease
Fetscherstrasse 74·01307 Dresden·Germany
Telefon: +49/351/458 27 15
Fax: +49/351/458 87 03·
eMail: pschwarz@rcs.urz.tu-dresden.de