Evidence base
Cost effective prevention
Consequences of inaction
Potential for success

The prevention of type 2 diabetes has wide connotations throughout society. Health services have a part to play in identifying ‘at risk’ individuals, and advocating and supporting one or more of the effective person-based interventions. However, in terms of preventing type 2 diabetes (by preventing obesity, for example), policies in education, transport, the form of our physical environment, leisure facilities, work, nutrition, food labelling and pricing, institutional catering and many more behavioural influences all have a part to play.

Although we now have sufficient firm evidence on the prevention of type 2 diabetes to be active, both in clinical and public health practice to act, this does not mean that we should cease to understand better the phenomena leading to type 2 diabetes in susceptible people. Two particularly fruitful areas for further research are the effects of early nutrition and the effects of external stresses on the nervous system of adults and, perhaps particularly, on the young developing individual. These areas may be interconnected as has been suggested   1 .

Reviews of the evidence on prevention suggest strongly that population-based measures aimed at maintaining or increasing physical activity and maintaining a health body weight or, where necessary, reducing body weight will be effective and cost-effective. Individual interventions to reduce risk of type 2 diabetes and cardiovascular disease in those at high risk will also work. Prevention strategies, therefore, must be at least two-fold:

• Population-based measures to encourage active lives and healthy weight maintenance; and
• Individually focussed measures to identify those at high risk and reduce that risk.

These population-based programmes must be tailored to local circumstances in order to be effective. The individually focussed measures, similarly, must adopt the most acceptable and affordable means of identification (possibly through risk assessment questionnaires such as that used in the Finnish national programme) followed by appropriate biochemical investigation and therapeutic measures to manage established diabetes if present, or ‘pre-diabetes’ (impaired glucose tolerance or fasting hyperglycaemia).

Practical examples of programmes already established to increase awareness, encourage healthier lifestyles and, in most instances, identify and manage individuals at high risk are shown here.

Examples of prevention programmes