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Prevention of diabetes: A reality in primary care?

2007; Elsevier BV; Volume: 1; Issue: 3 Linguagem: Inglês

10.1016/j.pcd.2007.07.003

1751-9918

Thomas Yates, Kamlesh Khunti, Melanie Davis,

Chronic Disease Management Strategies

Type 2 diabetes melitus is a growing health problem, with the prevalence of the disease set to rise dramatically in westernised societies [ [1] International Diabetes Federation. 2006. Diabetes Atlas. http://www.eatlas.idf.org/media/Accessed2007/06/20. Google Scholar ]. Individuals with diabetes have a life expectancy that can be shortened by as much as 15 years with the majority dying of cardiovascular disease [ [2] Morgan C.L. Currie C.J. Peters J.R. Relationship between diabetes and mortality: A population study using record linkage. Diab. Care. 2000; 23: 1103-1107 Crossref PubMed Scopus (142) Google Scholar ]. The excess mortality, morbidity and the substantial healthcare costs associated with its rising prevalence make diabetes a major global health issue. Intervening to delay or prevent type 2 diabetes has the potential to improve health and to reduce the burden of health care costs. The total direct medical cost of managing diabetes in eight European countries is estimated at 29 billion euros a year (1999 value) [ [3] Palmer A.J. Roze S. Valentine W.J. Spinas G.A. Shaw J.E. Zimmet P.Z. Intensive lifestyle changes or metformin in patients with impaired glucose tolerance: Modeling the long-term health economic implications of the diabetes prevention program in Australia, France, Germany, Switzerland, and the United Kingdom. Clin. Ther. 2004; 26: 304-321 Abstract Full Text PDF PubMed Scopus (105) Google Scholar ]. This cost that is projected to substantially increase in line with the number of individuals identified with diabetes in the coming decades. It is therefore of primary importance to identify strategies that can successfully counter this worrying trend. Several successful diabetes prevention trials [ 4 Knowler W.C. Barrett-Connor E. Fowler S.E. Hamman R.F. Lachin J.M. Walker E.A. Nathan D.M. Diabetes Prevention Program Research GroupReduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N. Engl. J. Med. 2002; 346: 393-403 Crossref PubMed Scopus (14524) Google Scholar , 5 Tuomilehto J. Lindström J. Eriksson J.G. Valle T.T. Hämäläinen H. Ilanne-Parikka P. Keinänen-Kiukaanniemi S. Laakso M. Louheranta A. Rastas M. Salminen V. Uusitupa M. Finnish Diabetes Prevention Study GroupPrevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med. 2001; 344: 1343-1350 Crossref PubMed Scopus (8347) Google Scholar ] that have captured the attention of clinicians, governments and the media over the past decade have highlighted the importance of promoting lifestyle change in the fight against diabetes.