Inadequacies of current approaches to prediabetes and diabetes prevention
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Inadequacies of current approaches to prediabetes and diabetes prevention Michael Bergman
Received: 25 June 2013 / Accepted: 10 July 2013 Ó Springer Science+Business Media New York 2013
Abstract In view of the global shift from communicable to chronic, non-communicable diseases including obesity, prediabetes, and type 2 diabetes mellitus, the increasing prevalence of the latter creates a considerable challenge to the clinician and public health infrastructure. Despite the substantial research efforts in the last 10–15 years highlighting the considerable benefit of lifestyle modification in thwarting the insidious progression to diabetes and its complications, many individuals will ineluctably progress even when initially responsive. Furthermore, the vast majority of individuals with prediabetes remain undiagnosed and untreated. Therefore, the responsibilities of the medical and public health communities involve identifying new methods for screening and identifying those at risk as well as refining therapeutic approaches availing as many high-risk individuals as possible to novel treatment modalities. Keywords Diabetes Prediabetes Prevention Non-communicable diseases Translation
Epidemiology Increased prevalence of diabetes As many as 79 million people in the United States have prediabetes, representing more than one-third of adult Americans and half of all adults aged C65 years [1]. The yearly incidence of type 2 diabetes is 5–10 % in those with
M. Bergman (&) Division of Endocrinology and Metabolism, NYU Diabetes and Endocrine Associates, NYU School of Medicine, 530 First Avenue, Schwartz East, Suite 5E, New York, NY 10016, USA e-mail: [email protected]
prediabetes compared to about 1 % per year in the general adult population. Global life expectancy has increased continuously and substantially in the past 40 years although considerable heterogeneity exists across age-groups, countries, and different decades [2]. The United States spends more on health care than any other country, but health outcomes are generally worse than in other wealthy nations [3, 4]. Up to the age of 75, males and females have shorter life expectancies than in 16 other developed nations [3]. Among other considerations, this is attributed to highest obesity rates, consumption of more calories per capita, and prevalence of diabetes among adults aged 20 years and older [3, 4]. High prevalence of obesity is seen in US children and in every age-group thereafter. From age 20 onward, US adults have among the highest prevalence rates of diabetes and glucose levels among peer countries [4]. The elevated obesity rate, with 64 % of US adults with overweight or obese, could in part be explained by the decline in weight, dietary, and exercise counseling by United States despite patient expectations to the contrary. Greater declines in counseling have been observed among individuals with hypertension, diabetes, and obesity who stand the most to gain from weight loss [5]. Shift to non-communicable diseases Compared with sub
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