Prevention, Remission or Delaying Type 2 Diabetes-Manifestation - Part 1

Prevalence and incidence of diabetes and especially type 2 diabetes are worldwide growing dramatically. In 2019 around 463 million people suffered from diabetes with an enormous increase to 700 million up to the year 2045. Realistic estimates report even a doubling of the prevalence when considering the undiagnosed cases. In Germany the prevalence of diabetes is around 10 %, of undiagnosed cases 2 % and of people with prediabetes (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] or both) 21 %. Diabetes and its complications account for at least 10-12 % of the total health expenditures in Germany. Prevention of type 2 diabetes together with other non-communicable diseases is therefore paramount to curtail this already existing health crisis. Drawing on the evidence from high quality randomized controlled trials, systematic reviews and meta-analyses lifestyle interventions are effective to prevent or delay the manifestation in high risk populations (i. e. prediabetes), which have to be identified by evaluated screening tools like the FINDRISK questionnaire and/or blood glucose parameters plus HbA 1c. The strategies for a successful prevention are attacking multiple risk factors for the development of type 2 diabetes (f. e. obesity/fatty liver, physical inactivity, unhealthy eating and drinking including alcohol as well as coffee and tea consumption, smoking, sleeping disorders, depression) with non-pharmacological behavioural prevention which will be discussed in this evidence-based review (part 1 of this CME paper). Part 2 deals with important aspects of a setting-based/environmental prevention. Both behavioural and environmental prevention strategies have closely work together in order to achieve long-lasting successes in diabetes prevention. © 2020 Georg Thieme Verlag. All rights reserved.