Lifestyle interventions

Diabetes is the commonest non-communicable disease worldwide. Researchers predict it will increase by around 160% by the year 2025. Sadly, most of this increase will occur in developing countries, which have the least resources to deal with the problem. Even in the most developed countries, health systems are struggling to meet demands for services. In recent years, this has led to a strong focus on prevention research.

We know that in both Western and Asian adults in the vulnerable overweight groups with impaired glucose tolerance, modest weight loss with specific changes in diet and physical activity can reduce the likelihood of developing Type 2 diabetes. Marked weight loss in severely obese people with diabetes can also ameliorate the risks from their diabetes perhaps for a decade or more. However, clinical interventions to achieve this require intensive personal supervision, which,

So-called 'late onset diabetes' is now more widely termed Type 2 diabetes. And for very good reasons. It was previously the case that childhood and adolescent diabetes was nearly exclusively Type 1 diabetes and that Type 2 diabetes very rarely affected the young. Sadly, this is no longer true. As the spread of 'westernized' lifestyles gives rise to a steep increase in rates of obesity worldwide, Type 2 diabetes is rapidly emerging among children and adolescents.

In 1992, the Singapore government noted that the obesity prevalence among schoolchildren was 14%. Singapore's population has a relatively high prevalence of diabetes, at 9.2%. Rates of obesity and overweight are high – 6% of the adult population has a body mass index (BMI) of more than 30 kg/m2, and around 25% have a BMI above 25 kg/m2. Recent years have also seen the increasing appearance of young onset Type 2 diabetes and impaired glucose

Diabetes prevention takes many forms. Other articles in this issue of Diabetes Voice describe primary prevention of Type 2 diabetes (the diabetes of obesity and Western lifestyles), while secondary prevention is the use of lifestyle

Type 2 diabetes increases the risk of cardiovascular disease (CVD) between two- and six-fold, and shortens life expectancy by 5 to 10 years. Once a person with diabetes has developed severe vascular complications, they will

Until recently, randomized clinical trials offered only limited proof that Type 2 diabetes is preventable by changes in lifestyle. Fortunately, this gap has now been filled. Several major lifestyle intervention trials have been successfully completed. The results are consistent: the risk of Type 2 diabetes can be halved in people who are at high risk; the effect of lifestyle change is rapid; the lifestyle changes required to achieve a significant risk reduction do not have to be drastic; and benefits are similar in different ethnic groups.

Previously disregarded due to the lack of strong clinical evidence supporting its effectiveness in the treatment of diabetes, the role of medical nutrition therapy has recently changed. This is all the more important given the link between diabetes and obesity, and the steady increase of the latter at a global level, particularly in the industrializing countries. So today, when advising on how to best manage the condition, diabetes healthcare teams are putting more and more emphasis on healthy lifestyles, of which nutrition is a major component.

Together with its 'twin sister', childhood obesity, Type 2 diabetes is spreading among young people around the world. This constitutes a serious public health problem; by their 30s, generations of young people will have been living with Type 2

In the United States, the latest data show that two out of three adults are overweight, and nearly one in three is obese. Alarmingly, similar trends are emerging around the world. In countries as diverse as the Czech Republic, Finland, Germany, Kuwait, and Mexico at least half the population is overweight and one in five is obese.