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Prevention of Type 2 Diabetes

Manfred Ganz (Edited by), M Ganz (Author)

9780470857335, Wiley

Hardback, published 7 January 2005

384 pages
25.2 x 17.4 x 2.7 cm, 0.85 kg

"…enjoyable and easy to read…a worthy library addition…" (The Annals of Pharmacotherapy, September 2005)

"…presents the latest global perspective on the affliction." (Electric Review, April/May 2005)

"This is a timely and helpful treatment of an important public health topic. I am unaware of any other contemporary books which address exactly this issue." (Doody's Health Services)

"An ambitious title, written by some of the world’s leading diabetologists, it takes a very careful approach …" (Pediatric Endocrinology Reviews (PER), Vol. 3: September 2005)

" … an excellent resource for professionals … a one-stop source for understanding the state of current prevention knowledge about type 2 diabetes." (Diabetes Technology & Therapeutics, August 2006) 

This book  provides a unique and comprehensive synopsis of the prevention and early diagnosis of Type 2 Diabetes. It features articles by key opinion leaders in diabetes from North America, Europe and the Asia-Pacific region who describe the gravity of the problem and the important issue of screening, including contributions on the perspectives of the International Diabetes Federation and the World Health Organization. 

Once patients at risk have been identified, the key issue is to prevent their progression to full-blown diabetes. Several chapters address this, particularly the difficult task of changing people’s behaviour. Prevention of the complications associated with diabetes involves more targeted interventions, which are discussed by experts in the relevant areas.

This book offers both a global perspective and local solutions. Key contributors include Paul Zimmet and Pierre Lefèbvre, President of the International Diabetes Federation who has written a chapter and a foreword.

Praise from the reviews:

"[A]n excellent resource for professionals who want a good means for getting up to speed on the prevention angle. It is all-inclusive from many perspectives – authorship of chapters, rich reference lists, and content (…). This book is a one-stop source for understanding the state of current prevention knowledge about type 2 diabetes."
DIABETES TECHNOLOGY & THERAPEUTICS

"This is a timely and helpful treatment of an important public health topic. I am unaware of any other contemporary books which address exactly this issue."
DOODY'S HEALTH SERVICES

"An ambitious title, written by some of the world’s leading diabetologists, it takes a very careful approach ( …)"
PEDIATRIC ENDOCRINOLOGY REVIEWS (PER)

Foreword xiii

Preface xv

List of Contributors xvii

Section 1 The Diabetes Epidemic: Description of the Problem 1

1 The Diabetes Epidemic; Genes and Environment Clashing 3
Paul Zimmet, Adrian Cameron and Jonathan Shaw

Introduction 3

An Epidemiological Perspective 3

The Hidden Epidemic – Impaired Glucose Tolerance and Impaired Fasting Glycaemia 6

Glucose Intolerance and the Metabolic Syndrome 6

Globalization – its Impact on Human Health 8

Type 2 Diabetes in Children and Adolescents 9

Prevention – the Reality and the Challenge 10

References 10

2 Type 2 Diabetes Mellitus: Primary and Secondary Prevention The Vision of the International Diabetes Federation 15
Pierre Lefèbvre

Introduction 15

Primary Prevention of Type 2 Diabetes Mellitus 16

Prevention of Complications of Type 2 Diabetes Mellitus 17

The Global Issue 18

References 19

3 Type 2 Diabetes Mellitus in Children and Adolescents 21
Thomas Reinehr and Martin Wabitsch

Introduction 21

Pathophysiology of Type 2 Diabetes Mellitus in Children and Adolescents 22

Epidemiology of Type 2 Diabetes Mellitus in Children and Adolescents 23

Clinical Presentation of Type 2 Diabetes Mellitus in Children and Adolescents 25

Clinical Features of Caucasian Children with Type 2 Diabetes Mellitus 25

Differential Diagnosis of Type 2 Diabetes Mellitus in Children and Adolescents 27

Diagnostic criteria of Type 2 Diabetes Mellitus in Children and Adolescents 29

Complications of Type 2 Diabetes Mellitus in Children and Adolescents 31

Screening for Type 2 Diabetes Mellitus in Children and Adolescents 33

Treatment of Type 2 Diabetes Mellitus in Children and Adolescents 34

Pharmacological Treatment of Type 2 Diabetes Mellitus in Children and Adolescents 35

Monitoring and Treatment of Complications of Type 2 Diabetes Mellitus in Children and Adolescents 37

Prevention of Type 2 Diabetes Mellitus in Children and Adolescents 37

Conclusions 38

References 38

Section 2 Screening for Type 2 Diabetes 41

4 Screening for Undiagnosed Diabetes: Whom, Where, When and How 43
Tim Kenealy, Bruce Arroll and Peter Müller

Undiagnosed Diabetes and Its Harms 43

The Rate of Undiagnosed Diabetes in New Zealand 43

Should We Screen for Diabetes? 45

Theory of Screening 48

Screening Theories are Difficult to Apply to Diabetes: Implications of the Diagnostic Criteria for Screening Decisions 55

Current Recommendations, New Zealand and International 56

Current Practice in New Zealand 56

Studies of Practical Screening in New Zealand 57

Systematic Opportunistic Screening in General Practice 58

Who to Test: Which Groups are at Relatively High Risk? 59

How to Test: Specific Screening Tests and cut-off Values? 62

Screening Intervals 71

Difficulty Applying Recommendations to Individual Patients 71

Screening Algorithms for Asymptomatic People 72

Summary 72

References 73

5 Genetic Screening and Prevention of Type 2 Diabetes 81
Paolo Pozzilli

Introduction 81

Lessons from Type 1 Diabetes for Genetic Screening 83

Methods for Early Prediction of Type 1 Diabetes and Prevention Strategies 84

Type 2 Diabetes: Where do We Stand as regards Genetic Screening 85

Genes that are Identified with a Predisposition to Type 2 Diabetes: the New Scene 86

How can We Track the Prediabetes Period using Genetic Markers? 87

Genetic Screening for MODY and Potential Preventive Strategy 88

Conclusion 90

Acknowledgements 91

References 91

6 Screening Parameters and Techniques: Limitations and Opportunities 93
Knut Borch-Johnsen and Charlotte Glümer

The Epidemiology of Type 2 Diabetes 94

What is Screening and How do We Evaluate a Screening Test? 95

Screening Strategies 96

Who Should be Screened – Targeted Screening Strategies Based on Phenotypical Characteristics? 99

Limitations, Perspectives and Recommendation 99

References 101

7 Screening for Diabetes Mellitus – the World Health Organization Perspective 105
Gojka Roglic, Rhys Williams and Stephen Colagiuri

Introduction 105

Formulating Policies on Screening for Type 2 Diabetes 109

Widening the Evidence Base 112

Implementing Policies on Screening for Type 2 Diabetes 117

Conclusions and Recommendations 117

References 120

Section 3 Prevention of Type 2 Diabetes 125

8 Findings from Preventive Type 2 Diabetes Trials 127
Markolf Hanefeld

The ‘Common Soil’ Hypothesis – a Rationale for Preventive Measures in Subjects with IGT 128

Lifestyle Trials with Prevention of Diabetes as Primary Objective 130

Pharmacological Trials with Prevention of Diabetes as Primary Objective 132

Coronary Heart Disease Prevention Trials with Prevention of Diabetes as the Secondary Objective 138

Studies for Primary Prevention of Diabetes in Progress 140

Is Impaired Glucose Tolerance (IGT) a Disease? 142

Who Should be Treated (and How)? 145

Do We Treat Type 2 Diabetes too Late? 146

References 147

9 A Paradigm Shift is Needed in the Primary Prevention of Type 2 Diabetes 153
Jaakko Tuomilehto

Primary Prevention of Type 2 Diabetes – the Current Paradigm 153

Re-Defining the Paradigm of Primary Prevention of Type 2 Diabetes 155

New Paradigm – A Population Approach for Prevention of Type 2 Diabetes 155

New Paradigm – Who is at High Risk? 156

New Paradigm – True Primary Prevention: Targeting People Before Their Blood Glucose Values are Abnormal 158

New Paradigm – Prevention of Complications of Type 2 Diabetes by Preventing Type 2 Diabetes Itself 159

New Paradigm – How could Money for Diabetes Care be Allocated in a More Efficient Way? 161

Comment 162

References 165

10 The Behaviour Change Process 169
Frank J. Snoek and Richard R. Rubin

Introduction 169

Readiness to Change 170

Goal Setting 172

Supporting Behaviour Change 172

Changes and Maintenance 173

Implications 175

References 176

Section 4 Prevention of Complications Of Type 2 Diabetes 179

11 Preventive Disease Management – Risk Stratification as a New Tool in the Hands of General Practitioners 181
Thomas Konrad

Chronic Diseases, Health-Care Systems, Internet and Economic Burden: From Intervention to Prevention 181

Basics of Preventive Medicine: Risk Stratification, Genetic Testing and Information 183

Principles of Assessment of Risk Factors in Clinical Practice for Cardiovascular Diseases and Diabetes Mellitus Type 2: Consequences for the Individual Life 185

Preventive Disease Management for Diabetes Mellitus Type 2 and Cardiovascular Diseases: Phenotyping – the Early Detection of Insulin Resistance and Endothelial Dysfunction 189

Integrative Preventive Care: Community-Based Strategy to Avoid Chronic Diseases 193

Summary 197

References 198

12 Prevention of Obesity and Lipid Disorders 203
Hermann Liebermeister

Reasons for Prevention 203

Problems in Prevention 212

Community-Based Prevention Studies 216

Promoting Physical Activity 218

Workside Interventions in Adults 220

Specific Weight Gain Prevention Trials in Adults 220

Prevention of Diabetes and Obesity 222

Prevention of Lipid Disorders 227

Perspectives of Obesity and Dyslipidaemia Prevention 230

Acknowledgement 234

References 235

13 Renal Dysfunction and Hypertension, Focus on Type 2 Diabetes 245
Carl Erik Mogensen

Introduction 245

Historical Aspects 246

Evaluation of Diabetic Renal Disease and Classification 246

Diagnostic Procedures 249

Prevention 251

Treatment Strategy 252

Treatment in Overt Diabetic Renal Disease 255

Recent Treatment Guidelines for Patients with Diabetes Mellitus with Focus on Hypertension 257

The Dual- or Triple- Jeopardy Concept 257

Goals for Blood Pressure 258

Old and Very New Guidelines 258

Screening for Microalbuminuria 259

Prevention and Intervention Related to Type 2 Diabetes 261

Summary 263

References 263

14 Diabetic Retinopathy in the 21st Century: Screening and Visual Outcomes 271
Ayad Al-Bermani and Roy Taylor

Introduction 271

Epidemiology 272

Good Glycaemic Control 272

Good Blood Pressure Control 272

Other Risk Factors 273

Screening 273

Effect of Screening Upon Rates of Blindness 277

Treatment of Diabetic Retinopathy 278

Panretinal Photocoagulation 278

Treatment of Macular Oedema 280

Vitrectomy 280

Summary 282

References 282

15 Prevention and Treatment of Diabetic Neuropathy 285
Anders A. F. Sima

Introduction 285

Clinical Presentation and Classification of DPN 286

Pathogenetic Mechanisms 288

Tested Therapies 292

Future Therapeutic Opportunities 296

Concluding Thoughts 300

References 301

16 The Cardiologist’s View: Prevention of Macrovascular Complications 313
Michael Faust, Sabine Wiedenmann and Reinhard Griebenow

Prevalence of Cardiovascular Complications in Patients with Diabetes Mellitus 313

Occurrence of Diabetes in Patients with Cardiovascular Disease 315

Prognosis and Course of Coronary Heart Disease in Diabetic Patients 315

Explanatory Models for the Particular Fatal Course of Coronary Heart Disease in Diabetic Patients (Risk Factors) 316

Cardiovascular Complications – Preventive and Therapeutic Options 317

Interventional Revascularization 319

Procedure in Critical Ischaemia 320

References 320

17 Milestones and New Perspectives in Prevention of Type 2
Diabetes and its Complications 325

Carl Erik Mogensen

Classification of Diabetes 325

Insulin Treatment with Focus on Euglycemia in Type 2 Diabetic Patients 327

Sulphonylurea (SU) Preparations 329

Metformin 330

Glitazones 330

The Metabolic Syndrome 331

Home Monitoring of Blood Glucose 331

Glycated Haemoglobin 332

Diabetes Nurses, ‘Diabetes School’ and Dietary Help 332

Laser Treatment of Retinopathy, including Maculopathy, in Type 2 Diabetes 333

Diabetic Foot Care and Related Neuropathy 333

High Blood Pressure: Blood Pressure Lowering and Microalbuminuria 333

Lipid-Lowering Agents; Focus on Type 2 Diabetes 335

The Diet of Diabetic Patients 336

Multi-Factorial Intervention with Treatment Goals 336

Neuropathy 336

Conclusion 337

References 338

Index 343

Subject Areas: Family & health [VF]

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