Over the past decades, we have observed an increase of prevalence of diabetes in many countries along with significant differences in prevalence trends between countries worldwide (1). In Europe and other Western countries, the prevalence rate reaches a plateau or has slowed down on the level of ;8-10%. In Asia, a continuous rise in prevalence has been monitored, similar to that in Africa, and an explosion of diabetes prevalence can be observed in the Arabic region.Surprisingly, in each of the countries, there is a significant number of people who do not develop diabetes during their lives despite living unhealthy lifestyles in similar environmentsdin Europe, an estimated 10% of the population (2). These people might be the secret answer to successful individual diabetes prevention, but we still do not understand the detailed mechanisms of why some people develop diabetesdand why others do not. What we can do is observe individual lifestyle and environment as determinants for the development or prevention of diabetes and the respective risk factors including genetic susceptibility. The interplay between these determinants, influencing the probability of the individual staying healthy or how a person learns or chooses a healthy lifestyle, will define success in diabetes prevention (3). Innovative actions are needed to slow down the progression of type 2 diabetes. The purpose of this article is to offer innovative policy and environmental strategic activities designed to enable sustainable diabetes prevention with scalability on national level.
Why Do We Need Environmental and Policy Changes in Diabetes Prevention?Diabetes prevention is a success story, but it generates new challenges. Throughout the past 15 years, a number of randomized controlled trials have sought to test various interventions to prevent diabetes (4). The results are overwhelmingly positive on an individual level, with a significant relative diabetes risk reduction attributed to lifestyle and pharmacological intervention (5). There are various indicators that lifestyle change leads to more sustainable and pleiotropic effects in preventing diabetes, whereas pharmacological interventions mimic an early glucose-lowering treatment and cease after the intervention has stopped. The results from the clinical trials tell a convincing scientific success story for diabetes prevention, but the logical proof of concept is the translation to community and national programs, including scalability of interventions within the population to prevent diabetes (6).Within the past years, a number of translational initiatives have been undertaken, varying in target population, scope of intervention, communication, and dissemination of activities. These trials were not as effective in reaching an individual outcome as the clinical trials, but they have initiated an effect on overall health (4,7). Common for the translational trial was a mild change in behavior in the target population leading to reduction of some risk factor or risk behavior (7). We can assume that t...