At the beginning of the twentieth century, a newly diagnosed diabetic patient had a life expectancy of 44 years. Little could be offered to treat diabetes except for dietary restriction and starvation, and death from hyperglycemic coma was common.
After the discovery of insulin in 1921, the average life expectancy in patients with diabetes rapidly increased to 61 years, death rates from coma declined, while death from cardiovascular disease, gangrene, and renal complications began to increase.
Diabetes research, for many years to follow, focused on understanding the pathophysiology behind diabetes and its complications, and the development of new treatments and technologies to improve the care of diabetic patients. Improvements in sanitation in the early 1900s resulted in an increase in life expectancy for the entire population, and by 1933, it was already recognized that the risk of developing diabetes increased with advancing age. In addition to advancing age, it was also noted that genetics and obesity contributed to one’s risk of developing diabetes. The social changes at the time allowed easier access to food, and the transition of labor from manual to mechanical in both urban and rural societies led greater numbers of people becoming overweight. Therefore, as the population was living longer and becoming more overweight, it was predicted that a rise in the incidence of diabetes was inevitable [ 2 ] . By the end of the twentieth century, diabetes was being described
as a global epidemic.
Life expectancy continued to rise; the social changes leading to overconsumption of food and an increasingly sedentary lifestyle caused the rates of obesity to escalate worldwide . As diabetes and its complications could be effectively managed with modern medicine, the cost of diabetes care was growing annually. Therefore, in the twenty- fi rst century, the focus of diabetes care is shifting toward diabetes prevention. In 1933, Joslin commented that diabetes is not a contagious disease and is a disease for the doctor to treat, rather than the state, the city, or the boards of health. However, given the extent of the current diabetes. epidemic, professional societies, health boards, and government are becoming increasingly involved in diabetes prevention and there have been suggestions that the epidemic should be addressed in a similar manner to the outbreak of an infectious disease .
Preventing Type 2 Diabetes
Many intervention studies have demonstrated that lifestyle modification in the setting of a clinical trial is at least as effective as pharmacological therapy for reducing the progression from prediabetes or the metabolic syndrome to T2DM. In a meta-analysis of studies examining the effect of lifestyle, diabetic medication, and antiobesity medication on the cumulative incidence of diabetes over 5 years, the number needed to treat (NNT) to prevent or delay one case of diabetes was 6.4 for lifestyle, 10.8 for antidiabetic medication, and 5.4 for orlistat. Bariatric surgery has also been reported to decrease the prevalence of prediabetes and T2DM. Therefore, treating individuals at risk for T2DM with lifestyle intervention, pharmacotherapy, or surgery can potentially delay or prevent the onset of T2DM. The increasing morbidity and mortality associated with diabetes, in addition to the rising diabetes-related healthcare expenditure, has led to the recognition of T2DM as a major public health concern.
The IDF, WHO, ADA, the National Cholesterol Education Program—Third
Adult Treatment Panel (NCEP-ATP III), along with representatives from every continent convened in Lisbon, Portugal in 2006 to create a consensus statement on T2DM prevention. In this statement, they proposed that T2DM prevention strategies should not only be targeted toward those individuals at high risk of developinT2DM, but also the general population. Those at higher risk of developing T2DM should be identi fi ed and lifestyle modi fi cation strategies should be advised, with the possible addition of pharmacological agents if lifestyle modi fi cation fails to achieve the desired results. Targeting the general population should go beyond the scope of
the healthcare sector; governments should be involved to establish health policy initiatives related to transportation and urban planning to promote physical activity; food pricing and advertising should promote healthy eating.
Education programs need to target children and adults to raise awareness of the risk of diabetes to the whole population and to help people understand the importance of healthy eating, maintaining a healthy weight, and exercising regularly. This consensus statement implores governments to change policies in order to empower people to improve their physical activity and develop healthy eating habits [ 36 ] . Others have suggested
that the epidemic of obesity and T2DM is not only related to lack of exercise and poor nutrition but also to a host of medical and environmental factors in a predisposed person that contribute to disease development. They therefore suggest that a wider approach needs to be taken to resolve the multiple causes of obesity and diabetes. Overall, diabetes prevention is becoming a priority for healthcare professionals and governments. The best method of identifying those at highest risk and the best method of prevention of the disease and its complications are the subject of intense research and heated debate.