Prevention of Type 2 Diabetes

Manfred Ganz, M.D.Specialist Internal Medicine, Diabetologist DDG, Medical Director Roche Diagnostics Global Diabetes Care, Mannheim/Germany.

"…enjoyable and easy to read…a worthy library addition…" (The Annals of Pharmacotherapy, September 2005) "…presents the latest global perspective on the affliction." (Electric Review, April/May 2005)"This is a timely and helpful treatment of an important public health topic. I am unaware of any other contemporary books which address exactly this issue." (Doody's Health Services)"An ambitious title, written by some of the world’s leading diabetologists, it takes a very careful approach …" (Pediatric Endocrinology Reviews (PER), Vol. 3: September 2005)" … an excellent resource for professionals … a one-stop source for understanding the state of current prevention knowledge about type 2 diabetes." (Diabetes Technology & Therapeutics, August 2006)

• Foreword xiiiPreface xvList of Contributors xviiSection 1 The Diabetes Epidemic: Description of the Problem 11 The Diabetes Epidemic; Genes and Environment Clashing 3Paul Zimmet, Adrian Cameron and Jonathan ShawIntroduction 3An Epidemiological Perspective 3The Hidden Epidemic – Impaired Glucose Tolerance and Impaired Fasting Glycaemia 6Glucose Intolerance and the Metabolic Syndrome 6Globalization – its Impact on Human Health 8Type 2 Diabetes in Children and Adolescents 9Prevention – the Reality and the Challenge 10References 102 Type 2 Diabetes Mellitus: Primary and Secondary Prevention The Vision of the International Diabetes Federation 15Pierre LefèbvreIntroduction 15Primary Prevention of Type 2 Diabetes Mellitus 16Prevention of Complications of Type 2 Diabetes Mellitus 17The Global Issue 18References 193 Type 2 Diabetes Mellitus in Children and Adolescents 21Thomas Reinehr and Martin WabitschIntroduction 21Pathophysiology of Type 2 Diabetes Mellitus in Children and Adolescents 22Epidemiology of Type 2 Diabetes Mellitus in Children and Adolescents 23Clinical Presentation of Type 2 Diabetes Mellitus in Children and Adolescents 25Clinical Features of Caucasian Children with Type 2 Diabetes Mellitus 25Differential Diagnosis of Type 2 Diabetes Mellitus in Children and Adolescents 27Diagnostic criteria of Type 2 Diabetes Mellitus in Children and Adolescents 29Complications of Type 2 Diabetes Mellitus in Children and Adolescents 31Screening for Type 2 Diabetes Mellitus in Children and Adolescents 33Treatment of Type 2 Diabetes Mellitus in Children and Adolescents 34Pharmacological Treatment of Type 2 Diabetes Mellitus in Children and Adolescents 35Monitoring and Treatment of Complications of Type 2 Diabetes Mellitus in Children and Adolescents 37Prevention of Type 2 Diabetes Mellitus in Children and Adolescents 37Conclusions 38References 38Section 2 Screening for Type 2 Diabetes 414 Screening for Undiagnosed Diabetes: Whom, Where, When and How 43Tim Kenealy, Bruce Arroll and Peter MüllerUndiagnosed Diabetes and Its Harms 43The Rate of Undiagnosed Diabetes in New Zealand 43Should We Screen for Diabetes? 45Theory of Screening 48Screening Theories are Difficult to Apply to Diabetes: Implications of the Diagnostic Criteria for Screening Decisions 55Current Recommendations, New Zealand and International 56Current Practice in New Zealand 56Studies of Practical Screening in New Zealand 57Systematic Opportunistic Screening in General Practice 58Who to Test: Which Groups are at Relatively High Risk? 59How to Test: Specific Screening Tests and cut-off Values? 62Screening Intervals 71Difficulty Applying Recommendations to Individual Patients 71Screening Algorithms for Asymptomatic People 72Summary 72References 735 Genetic Screening and Prevention of Type 2 Diabetes 81Paolo PozzilliIntroduction 81Lessons from Type 1 Diabetes for Genetic Screening 83Methods for Early Prediction of Type 1 Diabetes and Prevention Strategies 84Type 2 Diabetes: Where do We Stand as regards Genetic Screening 85Genes that are Identified with a Predisposition to Type 2 Diabetes: the New Scene 86How can We Track the Prediabetes Period using Genetic Markers? 87Genetic Screening for MODY and Potential Preventive Strategy 88Conclusion 90Acknowledgements 91References 916 Screening Parameters and Techniques: Limitations and Opportunities 93Knut Borch-Johnsen and Charlotte GlümerThe Epidemiology of Type 2 Diabetes 94What is Screening and How do We Evaluate a Screening Test? 95Screening Strategies 96Who Should be Screened – Targeted Screening Strategies Based on Phenotypical Characteristics? 99Limitations, Perspectives and Recommendation 99References 1017 Screening for Diabetes Mellitus – the World Health Organization Perspective 105Gojka Roglic, Rhys Williams and Stephen ColagiuriIntroduction 105Formulating Policies on Screening for Type 2 Diabetes 109Widening the Evidence Base 112Implementing Policies on Screening for Type 2 Diabetes 117Conclusions and Recommendations 117References 120Section 3 Prevention of Type 2 Diabetes 1258 Findings from Preventive Type 2 Diabetes Trials 127Markolf HanefeldThe ‘Common Soil’ Hypothesis – a Rationale for Preventive Measures in Subjects with IGT 128Lifestyle Trials with Prevention of Diabetes as Primary Objective 130Pharmacological Trials with Prevention of Diabetes as Primary Objective 132Coronary Heart Disease Prevention Trials with Prevention of Diabetes as the Secondary Objective 138Studies for Primary Prevention of Diabetes in Progress 140Is Impaired Glucose Tolerance (IGT) a Disease? 142Who Should be Treated (and How)? 145Do We Treat Type 2 Diabetes too Late? 146References 1479 A Paradigm Shift is Needed in the Primary Prevention of Type 2 Diabetes 153Jaakko TuomilehtoPrimary Prevention of Type 2 Diabetes – the Current Paradigm 153Re-Defining the Paradigm of Primary Prevention of Type 2 Diabetes 155New Paradigm – A Population Approach for Prevention of Type 2 Diabetes 155New Paradigm – Who is at High Risk? 156New Paradigm – True Primary Prevention: Targeting People Before Their Blood Glucose Values are Abnormal 158New Paradigm – Prevention of Complications of Type 2 Diabetes by Preventing Type 2 Diabetes Itself 159New Paradigm – How could Money for Diabetes Care be Allocated in a More Efficient Way? 161Comment 162References 16510 The Behaviour Change Process 169Frank J. Snoek and Richard R. RubinIntroduction 169Readiness to Change 170Goal Setting 172Supporting Behaviour Change 172Changes and Maintenance 173Implications 175References 176Section 4 Prevention of Complications Of Type 2 Diabetes 17911 Preventive Disease Management – Risk Stratification as a New Tool in the Hands of General Practitioners 181Thomas KonradChronic Diseases, Health-Care Systems, Internet and Economic Burden: From Intervention to Prevention 181Basics of Preventive Medicine: Risk Stratification, Genetic Testing and Information 183Principles of Assessment of Risk Factors in Clinical Practice for Cardiovascular Diseases and Diabetes Mellitus Type 2: Consequences for the Individual Life 185Preventive Disease Management for Diabetes Mellitus Type 2 and Cardiovascular Diseases: Phenotyping – the Early Detection of Insulin Resistance and Endothelial Dysfunction 189Integrative Preventive Care: Community-Based Strategy to Avoid Chronic Diseases 193Summary 197References 19812 Prevention of Obesity and Lipid Disorders 203Hermann LiebermeisterReasons for Prevention 203Problems in Prevention 212Community-Based Prevention Studies 216Promoting Physical Activity 218Workside Interventions in Adults 220Specific Weight Gain Prevention Trials in Adults 220Prevention of Diabetes and Obesity 222Prevention of Lipid Disorders 227Perspectives of Obesity and Dyslipidaemia Prevention 230Acknowledgement 234References 23513 Renal Dysfunction and Hypertension, Focus on Type 2 Diabetes 245Carl Erik MogensenIntroduction 245Historical Aspects 246Evaluation of Diabetic Renal Disease and Classification 246Diagnostic Procedures 249Prevention 251Treatment Strategy 252Treatment in Overt Diabetic Renal Disease 255Recent Treatment Guidelines for Patients with Diabetes Mellitus with Focus on Hypertension 257The Dual- or Triple- Jeopardy Concept 257Goals for Blood Pressure 258Old and Very New Guidelines 258Screening for Microalbuminuria 259Prevention and Intervention Related to Type 2 Diabetes 261Summary 263References 26314 Diabetic Retinopathy in the 21st Century: Screening and Visual Outcomes 271Ayad Al-Bermani and Roy TaylorIntroduction 271Epidemiology 272Good Glycaemic Control 272Good Blood Pressure Control 272Other Risk Factors 273Screening 273Effect of Screening Upon Rates of Blindness 277Treatment of Diabetic Retinopathy 278Panretinal Photocoagulation 278Treatment of Macular Oedema 280Vitrectomy 280Summary 282References 28215 Prevention and Treatment of Diabetic Neuropathy 285Anders A. F. SimaIntroduction 285Clinical Presentation and Classification of DPN 286Pathogenetic Mechanisms 288Tested Therapies 292Future Therapeutic Opportunities 296Concluding Thoughts 300References 30116 The Cardiologist’s View: Prevention of Macrovascular Complications 313Michael Faust, Sabine Wiedenmann and Reinhard GriebenowPrevalence of Cardiovascular Complications in Patients with Diabetes Mellitus 313Occurrence of Diabetes in Patients with Cardiovascular Disease 315Prognosis and Course of Coronary Heart Disease in Diabetic Patients 315Explanatory Models for the Particular Fatal Course of Coronary Heart Disease in Diabetic Patients (Risk Factors) 316Cardiovascular Complications – Preventive and Therapeutic Options 317Interventional Revascularization 319Procedure in Critical Ischaemia 320References 32017 Milestones and New Perspectives in Prevention of Type 2Diabetes and its Complications 325Carl Erik MogensenClassification of Diabetes 325Insulin Treatment with Focus on Euglycemia in Type 2 Diabetic Patients 327Sulphonylurea (SU) Preparations 329Metformin 330Glitazones 330The Metabolic Syndrome 331Home Monitoring of Blood Glucose 331Glycated Haemoglobin 332Diabetes Nurses, ‘Diabetes School’ and Dietary Help 332Laser Treatment of Retinopathy, including Maculopathy, in Type 2 Diabetes 333Diabetic Foot Care and Related Neuropathy 333High Blood Pressure: Blood Pressure Lowering and Microalbuminuria 333Lipid-Lowering Agents; Focus on Type 2 Diabetes 335The Diet of Diabetic Patients 336Multi-Factorial Intervention with Treatment Goals 336Neuropathy 336Conclusion 337References 338Index 343