Primary Prevention of Type 2 Diabetes and Its Economic Implications

Diabetes is the single most important metabolic disease which causes death and disability world-wide. Global presence of type 2 diabetics in the year 2000 is 171 million which is likely to be 366 million in the year 2030. India has the highest prevalence of diabetics in the world with 32 million and expected to increase to 80 million by 2030 accounting for almost 1/6th of world diabetic population1. Further several migrant studies have shown that South-Asians are more prone to diabetes compare to indigenous population2. The marked escalation in the growth of diabetes population is due to rapid changes in life style following urbanization, lack of physical exercise and nutrition transition. The ageing population may also be an additional factor. Further to the epidemic proportion of diabetes in India there is a hidden population of pre-diabetics. Impaired glucose tolerance (IGT) with 2 hours postprandial value of 140-199 mg/dl, and impaired fasting glucose(IPG) with value of 100-125 mg/dl are both considered to be prediabetics according to WHO and American Diabetic Association classification prediabetic subjects are for higher risk for diabeties and coronary heart disease. It occurs well before type2 diabetes and the conversion rate varies in different populations indicating ethnic differences3-5. The epidemiological studies conducted in urban India revealed the prevalence of IGT ranged between 10.6% and 16.8%6. In rural India it is about 7.18%7. In a prospective study followed up for 2-10 years of IGT subjects, 1/3 developed diabetes, 1/3 remained as IGT and 1/3 reverted to normal8. The interval period to develop diabetes from prediabetes gives an opportunity for preventive strategies. PREVENTION