Question

What are the level of prevention strategies for diabetes at primary secondary and tertiary - individual, community and national level strategies and policies available?

Answer 1

Diabetes prevention strategies at individual level:

For primary prevention of diabetes to be successful, we need to address the causative factor or factors in its aetiology.

The primary prevention of diabetes could Theoretically be achieved by genetic or environmental manipulation.

A much more likely approach to the primary prevention of diabetes is through lifestyle changes that favourably influence insulin sensitivity and insulin secretory capacity. These changes would include the avoidance of obesity, increased physical activity, dietary modification and optimization of the intrauterine environment.

Avoidance of obesity: halves the future risk of diabetes in those subjects at increased risk such as women with a history of previous gestational diabetes.

Obesity is associated with decreased insulin sensitivity characterized by decreased insulin-stimulated glucose uptake in muscle and reduced insulin suppression of hepatic glucose production.

. Abdominal rather than gluteal fat is associated with greater insulin insensitivity and an increased prevalence of diabetes.

Potential for increased physical activity: Increasing physical activity in both men and women reduces the incidence of diabetes in both individuals at low and high risk of diabetes.

Dietary modification: The dietary inclusion of anti-oxidants such as vitamin E may also improve insulin sensitivity and provide extra cardio protection in diabetes by reducing free radical activity.

Optimizing the intrauterine environment: Low birthweight is associated with an increased risk of future diabetes. . Maternal hyperglycaemia during pregnancy also predisposes to an earlier presentation of diabetes in the child.

Diabetes prevention strategies at community level:

The “high-risk approach,” which identifies and focuses exclusively on individuals at highest risk for developing diseases.

The first line of assessment would logically relate to patient screening and counseling on risk factors predicting subsequent development of diabetes.

The “population or public health approach,” which attempts to reduce risk factors for or causes of diseases within communities, which are generally defined in terms of localities but can also represent groups who share a common cause or interest.

The population approach, often called the community-based approach, offers a smaller benefit to individuals but more potential for benefiting the larger population.

In the health care system, ‘immediate actions’ might be designed to enhance risk identification and stratification, counseling on risk reduction, referral to proven community-based prevention programs and pharmacotherapy.

Such improvements might be accelerated by better adherence to practice guidelines, changes in reimbursement for preventive services and promotion of continuing medical education related to diabetes prevention.

In public health settings, immediate actions might include public dissemination of prevention messages via the mass media, Internet and care providers as well as policies to fund implementation of evidence-based programs and regulations in schools, worksites, community organizations and health care settings.

The public health sector has a major role in monitoring diabetes risk, mobilizing partnerships to establish diabetes prevention services for individuals at high risk and assuring the quality of these programs.

Furthermore, the public health sector needs to examine policies that support risk reduction by facilitating lifestyle modification and changes to community environments that make it easier to practice healthy behaviors.

Federal agencies, voluntary organizations, and others aim to reduce the burden of diabetes by translating research findings into practice at multiple levels, including providing support and assistance to states and territories to develop comprehensive, sustainable programs to prevent and treat diabetes among their constituents.

To evaluate the promise of primary prevention of diabetes using community-based approaches, the Centers for Disease Control and Prevention conducted a literature review to examine community-based interventions.

The clinical sector plays a significant role in identifying risk status, referring individuals at high risk to community-based lifestyle programs, providing nutrition counseling, prescribing medication when required and treating those who develop diabetes.

Diabetes prevention strategies at national level:

The National Diabetes Prevention Program—or National DPP—was created in 2010 to address the increasing burden of prediabetes and type 2 diabetes in the United States.

This national effort created partnerships between public and private organizations to offer evidence-based, cost-effective interventions that help prevent type 2 diabetes in communities across the United States.

One key feature of the National DPP is the CDC-recognized lifestyle change program, a research-based program focusing on healthy eating and physical activity which showed that people with prediabetes who take part in a structured lifestyle change program can cut their risk of developing type 2 diabetes by 58% (71% for people over 60 years old).

The CDC Diabetes Prevention Recognition Program (DPRP) assures program quality, consistency, provides a registry of recognized programs and implements standardized reporting on performance of recognized programs.

The YMCA and UnitedHealth Group (UHG) are the first to participate in the National DPP and are collaborating on instituting community-based prevention programs in which the YMCA delivers the lifestyle change program while the UHG provides third-party reimbursement for its beneficiaries.

The International Diabetes Federation has been instrumental in providing an overall framework representing the global diabetes community

The UN and its agencies are advised to work with national governments to reorient health systems to a preventative model addressing health in all polices, such as urban design and housing, workplace design, food production, healthy nutrition and physical activity.

Governments, in concert with the private sector, need to set policies that promote healthy nutritional and agricultural policies, favor modifications in the environment that encourage greater physical activity and make prevention affordable for all citizens at high risk.