title: Effectiveness of community-wide and individual high-risk strategies to prevent diabetes: a modelling study.
abstract: BACKGROUND
  Diabetes has been described as one of the most important threats to the health of developed countries. Effective population strategies to prevent diabetes have not been determined but two broad strategies have been proposed: "high-risk" and "community-wide" strategies.
  
  
  METHODS
  We modelled the potential effectiveness of two strategies to prevent 10% of new cases of diabetes in Ontario, Canada over a 5-year period. The 5-year risk of developing physician-diagnosed diabetes was estimated for respondents to the Canadian Community Health Survey 2003 (CCHS 2.1, N = 26 232) using a validated and calibrated diabetes risk tool (Diabetes Population Risk Tool [DPoRT]). We estimated how many cases of diabetes could be prevented using two different strategies: a) a community-wide strategy that would uniformly reduce body mass index (BMI) in the entire population; and b) a high baseline risk strategy using either pharmacotherapy or lifestyle counselling to treat people who have an increased risk of developing diabetes.
  
  
  RESULTS
  In 2003, the 5-year risk of developing diabetes was 4.7% (383 600 new diagnosed cases of diabetes in 8 189 000 Ontarians aged 20+) and risk was moderately diffused (0.5%, 3.1% and 17.9% risk in the 1(st), 5(th) (median) and 10(th) deciles of risk). A 10% reduction in new cases of diabetes would have been achieved under any of the following scenarios: if BMI was 3.5% lower in the entire population; if lifestyle counselling covered 32.2% of high-risk people (371 900 of 1 155 000 people with 5 year diabetes risk greater than 10%); or, if pharmacotherapy covered 65.2% of high-risk people.
  
  
  CONCLUSIONS
  Prevention using pharmacotherapy alone requires unrealistically high coverage levels to achieve modest population reduction in new diabetes cases. On the other hand, in recent years few jurisdictions have been able to achieve a reduction in BMI at the population level, let alone a reduction of BMI of 3.5%.
authors: The Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. dmanuel@ohri.ca
authors: Douglas G
authors: DG
authors: Manuel
authors: Laura C
authors: LC
authors: Rosella
authors: Meltem
authors: M
authors: Tuna
authors: Carol
authors: C
authors: Bennett
authors: Thérèse A
authors: TA
authors: Stukel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008019:Life Style; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009864:Ontario / Q000453:epidemiology; D011634:Public Health / Q000379:methods; D012307:Risk Factors; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents