Primary prevention of diabetes mellitus: current strategies and future trends

Aim of this paper is to find evidence for primary prevention of type-2 diabetes mellitus (T₂DM) from epidemiological studies and clinical trials, and the feasibility of applying these interventions in resource limited countries. T₂DM, which accounts for more than nine-tenths of all diabetics, results from inadequate insulin secretion or underlying insulin resistance. The prevalence of diabetes, mainly T₂DM, 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 T₂DM 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 T₂DM is based on elimination of these risk factors. This evidence that T₂DM is preventable comes from epidemiologic studies and clinical trials of effect of lifestyle changes and drugs in development of T₂DM. 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 long-term follow-up. However, there is a major challenge in translating this evidence into economically viable and sustained community programs, as these LSM interventions are expensive, even from western standards point of view. 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.