Detection and Early Lifestyle Intervention in Those at Risk of Type 2 Diabetes

The prevalence of Type 2 diabetes mellitus (T2DM) has reached epidemic proportions in recent years. It is now widely recognised that T2DM is a highly preventable disease. This article highlights the evidence to date for the prevention of T2DM. In order to prevent or delay the onset of T2DM, people at high risk of developing the condition need to be identified and treated using evidenced-based and cost-effective approaches. Risk scores offer a quick, simple way of identifying those at high risk for invitation to screening programmes without the need for initial invasive tests. Best practice guidance, including those from National Institute for Health and Clinical Excellence (NICE) in the UK and the European wide IMAGE project, recommend that a two-stepped approach whereby the identification of a high-risk status through risk score technology is confirmed by a blood test. Once identified, those at high risk can be offered a lifestyle intervention programme. Landmark diabetes prevention studies show that lifestyle intervention, focusing on increases in physical activity, improvements in diet, and reductions in weight, reduces the risk of progression to T2DM by 30-60% and can have lasting benefits after the active intervention ceases. Recent pragmatic prevention programmes also demonstrate encouraging results. However, research targeted to the prevention of T2DM must continue to be expanded to find the most effective methods of T2DM prevention in various societies and cultural settings. There is also a need for research focusing on young people at high risk and novel approaches, such as targeting a reduction in sitting and use of technology, to support behaviour change.