Is prevention of Type-2 diabetes feasible and efficient in primary care? A systematic PubMed review.
OBJECTIVE
To answer: (1) Do we have effective treatments to improve prognosis for those identified at risk of Type-2 diabetes? (2) Will prevention be cost-effective?


METHODS
A systematic search was done in PubMed using the following search strategy: "diabetes AND prevention AND (IFG OR IGT)". Restrictions were: "English, Meta-Analysis, Randomized Controlled Trial, Review, Humans".


RESULTS
Few randomised controlled preventive trials were found. Almost all were done in research settings in people with high risk of developing Type-2 diabetes. It seems possible to either delay or prevent Type-2 diabetes through lifestyle interventions and medication. Cost-utility analyses are few in number and come to very different conclusions as to whether health policy should promote prevention of Type-2 diabetes.


CONCLUSIONS
Intervention studies using lifestyle counselling and drug therapy in research settings illustrate promising results with lowering of the incidence of Type-2 diabetes, meaning that Type-2 diabetes can be delayed or prevented. It is, however, questionable whether these interventions are cost-effective. We need studies in routine clinical settings evaluating morbidity, mortality and cost-effectiveness as primary outcomes. While waiting for these studies to prove cost-effective, patients with pre-diabetes should be treated according to their 10-year risk of cardiovascular disease following present guidelines.
Lauritzen
Torsten
T
Institute of Public Health, Department of General Practice, University of Aarhus, Denmark. tl@alm.au.dk
Borch-Johnsen
Knut
K
Sandbaek
Annelli
A
D048909:Diabetes Complications / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D008019:Life Style; D011236:Prediabetic State / Q000191:economics / Q000517:prevention & control; D011322:Primary Prevention / Q000191:economics / Q000379:methods*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic