Prevention of Type 2 Diabetes

The rising prevalence of type 2 diabetes and the costs of managing the condition in developed and developing countries alike has driven an increased focus on the potential to design and implement preventive interventions. Meta-analyses of randomized controlled trials of individual-level behavioural interventions aimed at changing dietary and physical activity behaviour, mediated in most but not all populations by weight loss, have unequivocally established that these interventions are efficacious under the ideal circumstances that exist in clinical trials. Achieving comparable effectiveness in real-world settings has been much more challenging and there are as yet few examples of effective, scalable, and inexpensive interventions. Even in settings where individual-level interventions are affordable, such approaches need to be complemented by whole population approaches to prevention that implicitly acknowledge that the public health problem of diabetes cannot be dealt with by clinical approaches alone and needs a balanced approach of individual and societal-level action.