A European Evidence-Based Guideline for the Prevention of Type 2 Diabetes

Abstract

!Background: The prevalence and socioeconomic burden of type 2 diabetes (T2DM) and associated co-morbidities are rising worldwide. Aims: This guideline provides evidence-based recommendations for preventing T2DM. Methods: A European multidisciplinary consortium systematically reviewed the evidence on the effectiveness of screening and interventions for T2DM prevention using SIGN criteria. Results: Obesity and sedentary lifestyle are the main modifiable risk factors. Age and ethnicity are non-modifiable risk factors. Case-finding should follow a step-wise procedure using risk questionnaires and oral glucose tolerance testing. Persons with impaired glucose tolerance and/or fasting glucose are at high-risk and should be prioritized for intensive intervention. Interventions supporting lifestyle changes delay the onset of T2DM in high-risk adults (numberneeded-to-treat: 6.4 over 1.8-4.6 years). These should be supported by inter-sectoral strategies that create health promoting environments. Sustained body weight reduction by ≥ 5% lowers risk. Currently metformin, acarbose and orlistat can be considered as second-line prevention options. The population approach should use organized measures to raise awareness and change lifestyle with specific approaches for adolescents, minorities and disadvantaged people. Interventions promoting lifestyle changes are more effective if they target both diet and physical activity, mobilize social support, involve the planned use of established behaviour change techniques, and provide frequent contacts. Cost-effectiveness analysis should take a societal perspective. Conclusions: Prevention using lifestyle modifications in highrisk individuals is cost-effective and should be embedded in evaluated models of care. Effective prevention plans are predicated upon sustained government initiatives comprising advocacy, community support, fiscal and legislative changes, private sector engagement and continuous media communication.

Take Action to Prevent Diabetes – The IMAGE Toolkit for the Prevention of Type 2 Diabetes in Europe

“…3 Care pathway for healthcare provider. For further details, please see "IMAGE-Guideline for diabetes prevention" [15].…”

‘I saw what the future direction would be…’: Experiences of diabetes risk and physical activity after diabetes screening

“…Experiences of the risk of type 2 diabetes and physical activity 2 Several countries recommend targeted or opportunistic screening for early identification of individuals at high risk of type 2 diabetes (Paulweber et al, 2010;Saaristo et al, 2007;Simmons, Echuffo-Tcheugui, & Griffin, 2010). A thorough screening procedure should enable more accurate perceptions of risk, and lead to appropriate further tests and support for prevention (UK National Screening Committee, 2012).…”

“…A thorough screening procedure should enable more accurate perceptions of risk, and lead to appropriate further tests and support for prevention (UK National Screening Committee, 2012). Physical inactivity and a poor diet comprise major risk factors for diabetes along with impaired blood glucose, metabolic syndrome, and a family history of diabetes (Paulweber et al, 2010). High-risk individuals can substantially reduce their risk of type 2 diabetes by lifestyle changes that result in modest weight loss and increased physical activity (Tuomilehto et al 2001).…”

Personalisierte Medizin

“…auch Rippe et al, 2004 (Vassy & Meigs, 2012). Auch die Kombination von klinischen Daten und SNPs ist nur marginal besser als wenn nur die klinischen Daten verwendet werden -so gering, dass es sich aktuell nicht lohnt, die Genetik zu berücksichtigen (Paulweber et al, 2010).…”