Strategies for the prevention of type 2 diabetes

Type 2 diabetes is a common chronic disease affecting more than 100 million s of people world-wide, and is a major cause of premature morbidity and mor tality. Macrovascular disease and its risk factors are often already presen t in individuals at risk for type-2 diabetes, and some of the risk factors for the development of type 2 diabetes, such as obesity, physical inactivit y, and high-fat diet, can potentially be modified. Because some of the meta bolic abnormalities, such as insulin resistance or impaired glucose toleran ce, that indicate a risk for diabetes can be improved by lifestyle modifica tion and drug treatment, strategies. for the prevention of type 2 diabetes appear to be necessary for affected individuals. Several clinical trials ha ve addressed the hypothesis that type 2 diabetes can be prevented by dietar y modification, physical activity, or drug treatment. Although some of thes e studies indicate a protective effect of these measures against the develo pment of type 2 diabetes in people at risk, many of their conclusions are l imited with respect to randomisation, sample size, or intensity of the inte rvention. In the large prospective Da Qing study (1997), both dietary and p hysical activity interventions reduced the incidence of type 2 diabetes con siderably in a Chinese population. Whether this is also achievable in other ethnic populations at high risk for developing type 2 diabetes, and whethe r additional pharmacological measures are useful, is currently under invest igation.