Prevention of diabetes

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prevention of diabetes:

From public health perspective, prevention could be a cost-effective strategy.

Type 1:
• now have predictive markers (genetic and immunological) that now gives some prediction of the development of type 1 diabetes  potential for intervention due to long asymptomatic preclinical phase
• population screening not feasible (only 10% have first degree relatives with diabetes)

Major studies (results pending):
• American Diabetes Prevention Study (DPT-1)
• European Nicotinamide Diabetes Intervention Trial (ENDIT)
• Trial to Reduce Diabetes in the Genetically at Risk (TRIGR)

Type 2:
lifestyle interventions, especially exercise can reduce incidence of type two diabetes mellitus

Testing/screening:
American Diabetes Association criteria for testing for diabetes in the asymptomatic and undiagnosed individuals less than 40 years of age:
Those who have the following should be tested every three years:
first degree relatives with diabetes
excess weight or obesity
previous test showing impaired glucose tolerance
impaired fasting glucose
previous gestational diabetes or large baby
polycystic ovary syndrome
essential hypertension
hypertriglyceridaemia
low LDL-cholesterol levels
high risk ethnic origin
premature cardiovascular disease
corticosteroid, beta-blocker or high dose thiazide therapy
primary hyperuricaemia or gout
specific endocrinopathies (eg Cushing’s syndrome, acromegaly)
specific inherited disorders (eg Down syndrome)

Patients attending a Podiatric clinic could be considered a group that could be targeted for screening of for undiagnosed diabetes. However, Gill et al (1996) screened attendees at a podiatry clinic and found 0.4% had undiagnosed diabetes. 17.3% of those attending the clinic already had diagnosed diabetes. As the diagnostic returns were moderate, they recommended against this targeted screening.

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