In low-income countries preventing diabetes by means of lifestyle intervention is likely to be highly cost effective. Other methods to reduce the risk of cardiovascular disease in people at high risk are also attractive from the humanitarian and economic points of view. Another study   2  found that a number of population-based and person-based interventions to lower blood pressure would be cost effective in all regions of the world. Some of the results are shown in Table 1. Costs in international dollars (ID) per Disability Adjusted Life Years (DALY) saved range from below ID200 in countries such as Egypt, Iraq, Pakistan and Yemen to around ID1,500 in the wealthier countries of Europe, North America and Australasia.

Table 1 | Cost-effectiveness of a combined preventive strategy by region*

*Mean Expected Annual Costs (ID2000), Disability Adjusted Life Years saved, and Costs/DALY-saved for a combined programme of salt-reduction, mass media health education, and four-drug therapy for all citizens with CVD risk > 25%.

NA not available
Adapted from Murray et al, 2003   2 

As has been pointed out   3 , there is little direct (i.e. RCT) evidence that people at high risk selected specifically on the basis of other risk factors (those with a family history of diabetes, for example) can benefit from these (or other) interventions. Also, with the exception of the STOP-NIDDM trial   4 , none of the recent trials have directly demonstrated a reduction in risk of cardiovascular disease consequent upon the reduction in risk of transition to type 2 diabetes. (Although the Diabetes Prevention Program has demonstrated a reduction in surrogate risk factors   5 ). However, it could logically be argued that those with other risk factors should benefit and that cardiovascular risk should be reduced if the progression to diabetes can be delayed.

Additional to this possible benefit is that the early diagnosis of type 2 diabetes enables surveillance of the development of microvascular complications to be initiated and their treatment to be started if this is available and appropriate. If these preventive goals are realized, the potential health benefits, both to the individual and to society, are enormous. As a result, the global profile of diabetes would be transformed.