Potential for the prevention of type 2 diabetes

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Abstract
Type 2 diabetes is one of the most rapidly increasing chronic diseases in the world. The need for its primary prevention has been increasingly emphasised, although only during the past 10–15 years1 –6. The main justifications of prevention of type 2 diabetes are the possible prevention or postponement of complications related to type 2 diabetes in order to reduce both human suffering and the socio-economic burden on the community. It has been repeatedly shown that both symptomatic and asymptomatic diabetic patients have an increased prevalence of both macrovascular and microvascular complications by the time the disease is first diagnosed7 –9. A Swedish study showed that 77% of all costs for the care of type 2 diabetes were due to its complications, mostly cardiovascular10. Also, in people with impaired glucose tolerance (IGT), both mortality and the risk of cardiovascular disease are markedly increased11 ,12. It has been estimated that at the time of diagnosis of clinical type 2 diabetes only 50–60% of the pancreatic β-cell capacity is left, due to the fact that the disease process has already existed for more than 10 years13. Therefore, the optimal (and probably the only effective) strategy to reduce the increased burden of type 2 diabetes is primary prevention, i.e. to tackle the worsening of glucose intolerance before harmful effects of hyperglycaemia become permanent.