'Knowing what Matters in diabetes: Healthier below 7': results of the campaign's first 10 years (part 2), participants without known diabetes history.

Introduction: Type 2 diabetes represents a major problem in many societies. Early detection and, even better, prevention could help to reduce the burden of the disease. Therefore, increased awareness of disorders of glucose metabolism is important. During the campaign 'Knowing what Matters in diabetes: Healthier below 7', in the last few years, more than 31 000 shopping mall visitors in Germany were voluntarily checked for their potential diabetes risk.

Methods: With a modified FINDRISK questionnaire, demographic, anthropometric and anamnestic data relevant for the estimation of the potential diabetes risk were collected. In addition, medical data such as plasma glucose, blood pressure (BP), BMI and waist circumference were obtained. Furthermore, lifestyle habits were documented. Hemoglobin (Hb)A_1c was assessed randomly in a subgroup of individuals (n=4133). In total, data from 26 522 valid questionnaires were collected and evaluated over 10 years (2005-2014) from 45 single locations throughout Germany. Results from participants with manifest diabetes have already been published in this journal. Here, we report on the results from participants without a previous history of diabetes mellitus.

Results: Among the 26 522 participants with a completed questionnaire, 21 055 (79.4%) participants did not have a previous history of diabetes. Characteristic risk factors for diabetes were common in this group. With about 17% being obese and 40% being overweight, more than half of these individuals were thus beyond the normal BMI range. In addition, waist circumference exceeded common thresholds in 44% of the participants. As expected, many of them followed an unhealthy lifestyle as 35% reported no regular physical activity and 20% reported an unhealthy diet. The mean BP was 141/85 mmHg. More than half (51%) half of the patients in the nondiabetic group had a systolic BP above 140 mmHg, but only one-third (35%) reported concomitant treatment with antihypertensives. In the questionnaire, 14% of the participants had a FINDRISK sum score of 15 points and above, indicating a moderate or high risk of potentially developing type 2 diabetes within 10 years. Surprisingly, in the subgroup with HbA_1c measurements (n=4133), 18.5% of the participants without a diagnosis or a history of diabetes were found to have an HbA_1c value of at least 6.5% indicating manifest, previously undetected type 2 diabetes.

Conclusion: The data collected in individuals without a known history of diabetes indicate a considerable prevalence of typical risk factors associated with diabetes. In addition, the data confirmed that screening of apparently healthy individuals consistently shows a significant proportion of individuals with previously undetected type 2 diabetes which, in the subgroup, was surprisingly high. As there is convincing evidence for the beneficial effect of relatively simple lifestyle interventions such as an increase of physical activity and avoidance of unfavourable diets, and weight reduction, campaigns such as 'Knowing what Matters in diabetes: Healthier below 7' can be an appropriate option to encourage primary prevention among the sedentary population as well as a suitable tool for early disease recognition. Therefore, campaigns such as this should be intensified and options for early preventive intervention should be offered to reduce long-term disease burden and healthcare costs.