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Primary Prevention of Type 2 Diabetes: Lifestyle Intervention Works and Saves Money, but What Should Be Done with Smokers?

2005; American College of Physicians; Volume: 142; Issue: 5 Linguagem: Inglês

10.7326/0003-4819-142-5-200503010-00013

1539-3704

Jaakko Tuomilehto,

Chronic Disease Management Strategies

Editorials1 March 2005Primary Prevention of Type 2 Diabetes: Lifestyle Intervention Works and Saves Money, but What Should Be Done with Smokers?Jaakko Tuomilehto, MD, PhD, MPolScJaakko Tuomilehto, MD, PhD, MPolScFrom University of Helsinki, National Public Health Institute, Helsinki, Finland, and South Ostrobothnia Central Hospital, Seinajöki, Finland.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-5-200503010-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Reducing the risk factors that diseases have in common may prove to be an efficient prevention strategy (1, 2). For example, major risk factors, including obesity, physical inactivity, smoking, hypertension, hyperglycemia, and hyperlipidemia, predict the development of several chronic diseases, such as cardiovascular disease, cancer, diabetes, and dementia (3-5). Although one risk factor may confer a greater risk for a certain disease outcome than another risk factor, these risk factors are correlated and seem to operate in concert. A successful preventive intervention must, therefore, target several risk factors simultaneously (2, 6). This characteristic of preventive interventions means that they are ...References1. Rose G. Strategy of prevention: lessons from cardiovascular disease. Br Med J (Clin Res Ed). 1981;282:1847-51. [PMID: 6786649] CrossrefMedlineGoogle Scholar2. Epstein FH, Holland WW. Prevention of chronic diseases in the community—one-disease versus multiple-disease strategies. Int J Epidemiol. 1983;12:135-7. [PMID: 6874205] CrossrefMedlineGoogle Scholar3. Epstein FH, Francis T, Hayner NS, Johnson BC, Kjelsberg MO, Napier JA, et al. Prevalence of chronic diseases and distribution of selected physiologic variables in a total community, Tecumseh, Michigan. Am J Epidemiol. 1965;681:307-22. 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Lancet. 2002;359:2072-7. [PMID: 12086760] CrossrefMedlineGoogle Scholar12. Knowler WC, Narayan KM, Hanson RL, Nelson RG, Bennett PH, Tuomilehto J, et al. Preventing non–insulin-dependent diabetes. Diabetes. 1995;44:483-8. [PMID: 7729603] CrossrefMedlineGoogle Scholar13. Davey Smith G, Bracha Y, Svendsen KH, Neaton JD, Haffner SM, Kuller LH. Incidence of type 2 diabetes in the randomized Multiple Risk Factor Intervention Trial. Ann Intern Med. 2005;142:313-22. LinkGoogle Scholar14. Multiple risk factor intervention trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. JAMA. 1982;248:1465-77. [PMID: 7050440] CrossrefMedlineGoogle Scholar15. Stern MP, Williams K, Haffner SM. Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med. 2002;136:575-81. [PMID: 11955025] LinkGoogle Scholar16. Lindström J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26:725-31. [PMID: 12610029] CrossrefMedlineGoogle Scholar17. Rimm EB, Chan J, Stampfer MJ, Colditz GA, Willett WC. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ. 1995;310:555-9. [PMID: 7888928] CrossrefMedlineGoogle Scholar18. Zanchetti A, Ruilope LM. Antihypertensive treatment in patients with type-2 diabetes mellitus: what guidance from recent controlled randomized trials? J Hypertens. 2002;20:2099-110. [PMID: 12409940] CrossrefMedlineGoogle Scholar19. Marti B, Tuomilehto J, Salomaa V, Kartovaara L, Korhonen HJ, Pietinen P. Body fat distribution in the Finnish population: environmental determinants and predictive power for cardiovascular risk factor levels. J Epidemiol Community Health. 1991;45:131-7. [PMID: 2072072] CrossrefMedlineGoogle Scholar20. Herman WH, Hoerger TJ, Brandle M, Hicks K, Sorensen S, Zhang P, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142:323-32. LinkGoogle Scholar21. Finnish Diabetes Association. Development Programme for the Prevention and Care of Diabetes in Finland 2000–2010. Tampere, Finland: Finnish Diabetes Association; 2001. Google Scholar Author, Article, and Disclosure InformationAffiliations: From University of Helsinki, National Public Health Institute, Helsinki, Finland, and South Ostrobothnia Central Hospital, Seinajöki, Finland.Grant Support: By the Academy of Finland (46558).Disclosures: Honoraria: Merck & Co., Inc.; Stock ownership or option (other than mutual funds): Orion Pharma; Grants received: AstraZeneca, Novartis.Corresponding Author: Jaakko Tuomilehto, MD, PhD, MPolSc, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland; e-mail, jaakko.[email protected]fi. 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