Type 2 diabetes prevention in adults

Abstract

More than 80 million Americans are living today with a high risk for developing type 2 diabetes in the near future. This poses a considerable threat to population health, sparing no segment of our society and disproportionately affecting the poor, the aged, and racial and ethnic minorities. Though unhealthy diets and physical inactivity have been linked to increases in obesity and type 2 diabetes, these behaviors are driven less by individual decisions than by an existing social and physical environment where unhealthy behaviors have become more normative, enjoyable to most people, and easier to perform than healthier alternatives. Policy solutions designed to shift this environment have been slow to take hold, creating a missed opportunity for many people who will develop diabetes in the short term. Strong research has demonstrated the effectiveness of resource-intensive lifestyle support interventions to prevent or delay diabetes for people who participate. Unfortunately, only a small percentage of people at high risk for diabetes are currently taking part in such a program, despite their increasing availability in the community or via the Internet. A “complete” solution for type 2 diabetes prevention on a population scale will require multipronged approaches that combine efforts to increase the adoption of resource-intensive lifestyle support programs, along with longer-range, “macro-level” strategies such as policy, systems, and environmental changes. This chapter will review what is currently known about the prevention of type 2 diabetes, including the role of behavioral intervention programs combined with more “macro-level” solutions to achieve this goal.