Slowing Down the Progression of Type 2 Diabetes: We Need Fair, Innovative, and Disruptive Action on Environmental and Policy Levels!

Abstract

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...

The impact of health literacy on diabetes self-management education

“…HL is increasingly recognized as a key factor in public health and in the development of public health interventions (Schwarz and Riemenschneider, 2016;Van den Broucke, 2014). Low HL has been associated with poor health outcomes for many diseases, especially chronic diseases such as diabetes (Berkman, Sheridan, Donahue, Halpern and Crotty, 2011;Martin, Williams, Haskard and DiMatteo, 2005;Sabaté, 2003;Van den Broucke, 2014).…”

The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program

“…Interventions and actions at policy and environmental level need to supplement individual interventions for a sustainable reduction in T2D incidence [49]. The rising incidence is driven by a wide mix of factors at different levels, such as individual susceptibility, food supply, transportation use, climate change or the economic situation of the country [50].…”

Individualising Chronic Care Management by Analysing Patients’ Needs – A Mixed Method Approach

“…Financial issues, education of both patients and HCPs, access and availability of services as well as health promotion are the most important patient needs seen by patients and professionals. However, they will have to be accompanied by several innovative actions on individual and environmental level to slow down the progression of T2DM, in addition to approaches focusing on education and counselling [66]. …”