Primary Prevention of Type 2 Diabetes
Type 2 diabetes (T2DM), a global epidemic, now ranks among the leading noncommunicable public health challenges of the present era [1–3]. In 2015, The International Diabetes Federation (IDF) estimated that 415 million adults had diabetes worldwide, with T2DM accounting for 90%–95% of all diabetes cases . The public health burden imposed by diabetes is underscored by the fact that diabetes now is the leading cause of blindness, end-stage renal failure, and nontraumatic limb amputations, and a major contributor to heart disease, stroke, and peripheral vascular disease [4–7]. There is now abundant evidence from clinical trials that T2DM is preventable in adults through implementation of lifestyle interventions and/or medications. However, the achievement of sustained glycemic control to the level necessary for prevention of complications often proves elusive, even in countries in the developed economies [8,9]. Optimal glycemic control requires a highly motivated patient and regular contact points of that patient with the diabetic care team. The care process for an individual with diabetes includes many challenges: the use of multiple medications; frequent clinic visits; adherence to challenging lifestyle prescriptions; performance of demanding self-management tasks; paying for cumulative costs of home blood glucose monitoring equipment; sustained engagement by a team of physicians, nurses, dietitians, diabetes educators, ophthalmologists, podiatrists, behaviorists, and other specialized professionals; and the implementation of sundry other recommendations [10,11]. Translation of the results of clinical trials on diabetes prevention to the community at large presents additional challenges and involves focus on health and nutrition literacy, identification of persons at risk for T2DM, promotion of lifestyle intervention efforts, provision of community resources, and pertinent legislative action that rewards preventive behavior.