Paracelsus Medical University, Salzburg, Austria.
Horm Metab Res. 2010 Apr;42 Suppl 1:S3-36. doi: 10.1055/s-0029-1240928. Epub 2010 Apr 13.
The prevalence and socioeconomic burden of type 2 diabetes (T2DM) and associated co-morbidities are rising worldwide.
This guideline provides evidence-based recommendations for preventing T2DM.
A European multidisciplinary consortium systematically reviewed the evidence on the effectiveness of screening and interventions for T2DM prevention using SIGN criteria.
Obesity and sedentary lifestyle are the main modifiable risk factors. Age and ethnicity are non-modifiable risk factors. Case-finding should follow a step-wise procedure using risk questionnaires and oral glucose tolerance testing. Persons with impaired glucose tolerance and/or fasting glucose are at high-risk and should be prioritized for intensive intervention. Interventions supporting lifestyle changes delay the onset of T2DM in high-risk adults (number-needed-to-treat: 6.4 over 1.8-4.6 years). These should be supported by inter-sectoral strategies that create health promoting environments. Sustained body weight reduction by >or= 5 % lowers risk. Currently metformin, acarbose and orlistat can be considered as second-line prevention options. The population approach should use organized measures to raise awareness and change lifestyle with specific approaches for adolescents, minorities and disadvantaged people. Interventions promoting lifestyle changes are more effective if they target both diet and physical activity, mobilize social support, involve the planned use of established behaviour change techniques, and provide frequent contacts. Cost-effectiveness analysis should take a societal perspective.
Prevention using lifestyle modifications in high-risk individuals is cost-effective and should be embedded in evaluated models of care. Effective prevention plans are predicated upon sustained government initiatives comprising advocacy, community support, fiscal and legislative changes, private sector engagement and continuous media communication.
全球范围内 2 型糖尿病（T2DM）及其相关合并症的患病率和社会经济负担正在上升。
本指南提供了预防 T2DM 的循证建议。
一个欧洲多学科联盟使用 SIGN 标准系统地审查了 T2DM 预防的筛查和干预措施的有效性证据。
肥胖和久坐的生活方式是主要的可改变的危险因素。年龄和种族是不可改变的危险因素。病例发现应使用风险问卷和口服葡萄糖耐量试验进行逐步进行。糖耐量受损和/或空腹血糖升高的人处于高风险状态，应优先进行强化干预。支持生活方式改变的干预措施可延迟高危成年人 T2DM 的发病（1.8-4.6 年内每治疗 6.4 例可预防 1 例发病）。这些干预措施应得到跨部门战略的支持，以创造促进健康的环境。持续减轻体重 >或= 5%可降低风险。目前，二甲双胍、阿卡波糖和奥利司他可被视为二线预防选择。人群方法应使用有组织的措施来提高认识并改变生活方式，针对青少年、少数民族和弱势群体采取特定方法。如果干预措施针对饮食和体育锻炼、调动社会支持、涉及既定行为改变技术的计划使用以及提供频繁的接触，则更能有效促进生活方式的改变。成本效益分析应从社会角度出发。
在高危人群中通过生活方式改变进行预防具有成本效益，应将其纳入经过评估的护理模式中。有效的预防计划需要政府持续采取倡议、社区支持、财政和立法改革、私营部门参与和持续的媒体宣传等综合措施。
