Primary prevention of diabetes mellitus: current strategies and future trends

摘要

Aim of this paper is to find evidence for primary prevention of type-2 diabetes mellitus (T 2 DM) from epidemiological studies and clinical trials and the feasibility of applying these interventions in resource limited countries. T 2 DM, which accounts for more than nine-tenths of all diabetics, results from inadequate insulin secretion or underlying insulin resistance (IR). The prevalence of diabetes, mainly T 2 DM, has increased rapidly during the last few decades worldwide. Since the genetic background is unlikely to change during this short time period, the growing epidemic of T 2 DM is more likely due to changes in environmental or lifestyle risk factors including obesity, physical inactivity, smoking, alcohol and stress. The scope and feasibility for primary prevention of T 2 DM is based on elimination of these risk factors. This evidence that T 2 DM is preventable comes from epidemiologic studies and clinical trials of effect of lifestyle changes and drugs in development of T 2 DM. The positive effects are more profound and safer with lifestyle modifications (LSM) compared to medications. This is shown to be effective globally, across various ethnicities and races and sustainable on longterm follow-up. However, there is a major challenge in translating these evidences into economically viable and sustained community programs, as these LSM interventions are expensive, even by western standards. Future plan should focus on health education of the public, improving the national capacity to detect and manage the environmental risks including strategies to reduce stress, and development of innovative, cost effective, and scalable methodologies.