Reducing the risk of type 2 diabetes with nutrition and physical activity – efficacy and implementation of lifestyle interventions in Finland

Abstract

Background: The prevalence of type 2 diabetes has been increasing in Finland, in parallel with a gradual increase in overweight and obesity during the past decades. The expanding prevalence of type 2 diabetes brings along complications, most importantly CVD. Therefore, it is extremely important to implement activities to prevent type 2 diabetes. Objective: In the present paper, the clinical evidence for the prevention of type 2 diabetes is presented with the Finnish diabetes prevention study. In addition, the paper discusses the practical implementation of prevention of type 2 diabetes using three different types of prevention programmes as examples: FIN-D2D, including risk-screening and repeated consultation in primary health-care; FINNAIR, a workplace-targeted intervention project involving airline employees; and the good ageing in Lahti region (GOAL) programme, a community-based prevention programme. Conclusions: FIN-D2D, the FINNAIR project and the GOAL programme have shown that screening for type 2 diabetes risk and implementing large-scale lifestyle intervention in primary health-care are feasible. However, the crucial questions still are whether it is possible to replicate the results concerning effectiveness of lifestyle intervention in primary and occupational health-care systems. Furthermore, it remains to be shown whether it is possible to achieve the same results in different health-care settings, cultures, regions and age groups, especially in adolescents and young adults among whom the increase in the incidence has been the highest. In addition, the importance of co-operation among all sections of society, citizens' awareness of healthy lifestyles and the social inequalities in health must be emphasised because the diabetes epidemic cannot be solved only by concentrating on preventive actions carried out by health-care systems.

Type 2 Diabetes Prevention Programs; How Far are we?

“…Weight regain is very common in weight loss studies that use a behaviour intervention [93][94][95][96]. Thus, it is extremely difficult to maintain weight loss, even in studies where the intervention is still in full force and the enrolees are extremely well motivated.…”

Preventing Long-Term Complications of Obesity, Type 2 Diabetes, and Metabolic Syndrome

“…The latter is particularly important in the presence of chronic stress, increased (uncontrolled) caloric intake, and less-than-appropriate physical activities [i.e., adverse environmental influences] [39,40,55]. Moreover, metabolic syndrome is the underlying driver common to complications developing in persons with obesity and T2D [17,55,56].…”

“…The goal is to prevent individuals from becoming overweight or obese. Generally, this is achieved through education and monitoring appropriate lifestyle changes, motivating patients to adhere to advice and therapy to prevent gaining or regaining weight, and if necessary, prescribing medications [7,39,40,55]. However, for the intervention to be effective, clinicians should be able to motivate the patient to enhance his or her adherence to lifestyle changes and treatment [75].…”

“…Such changes include healthy eating and increasing physical activity [39,55]. However, the adherence to such plans is limited.…”

“…Relative inactivity and sedentary lifestyles lead to increased caloric intake, reduced energy metabolism, and the accumulation of body fat [39,55,75]. Although metabolic abnormalities and the underlying pathophysiology of insulin resistance are ill understood, in metabolically high-risk patients, there is a strong correlation between insulin resistance and CVD [7,31,47].…”