Early Intervention to Prevent Type 2 Diabetes

Diabetes mellitus is a global epidemic and a growing public health problem. The worldwide prevalence of diabetes is projected to increase from an estimated 171 million (2.8%) in 2002 to 366 million (4.4%) in 2030 [1]. The proportion of the U.S. population affected by diabetes is even greater. Based on data from the 1999–2002 National Health and Nutrition Examination Survey, 9.3% of those aged 20 years or older (19.3 million, 2002 U.S. population) had diagnosed or undiagnosed diabetes, and an additional 20.6% had impaired fasting glucose [2]. Diabetes was the sixth leading cause of death in the United States in 2002 [3]. The complications of diabetes— including heart disease, hypertension, stroke, blindness, renal disease, and peripheral neuropathy—contribute significantly to the morbidity and mortality associated with diabetes. The risk of death is roughly double in people with diabetes versus those without the disease [3]. The economic impact of diabetes also is enormous, with total (direct and indirect) costs estimated at $132 billion in 2002 [4]. In response to the clinical and economic burden of the diabetes epidemic, national guidelines call for strategies to prevent diabetes whenever possible. Although we refer to “prevention” in this article, we recognize that the diabetes prevention trials have shown that interventions more delay diabetes than prevent or reverse its pathophysiology. Thus, prevention of diabetes in this article should be understood to mean the delaying of the onset of diabetes. A case example will be used to examine the rationale for early, aggressive action on behalf of patients at risk for diabetes and its complications.