It would seem sensible to act to prevent or certainly delay the onset of Type 2 diabetes and there is plenty of evidence from around the world to suggest that this can be achieved1. There is also some evidence of population-based prevention from Cuba from their desperate ‘special period’ in the early 1990’s2. Economic conditions due to the collapse of the Soviet Union forced serious food supply and energy problems on the country. The decline in incidence of heart disease (35%) and diabetes(51%) was put down to the increased exercise forced upon the peopleand decreased calorie intake.
Screening is only useful if an effective intervention is available for those identified . And from my experience, this is difficult. I ran a research project based on best practice weight management and lifestyle techniques combined with the comprehensive internet resources of a major UK supermarket diet programme(this was to try to get round the problem of lack of dieticians in the NHS)3. The results led on to collaboration between the supermarket and primary care. The patient paid for a reduced rate internet subscription and the GP was funded for participation, but only after that participation had happened and then pro rata for follow up. I wrote to all of our identified people with pre-diabetes states informing them of the potential prevention of their condition and that local treatment was available, be it the funded scheme or any other initiative. Out of 79 letters there was not one reply.
This is a small local example highlighting the problem of engagement. There seems little point in identifying your population if then the population does not necessarily want that intervention. Perhaps it is in the way you sell it but marketing and advertising at least to match the food industry may be needed. Whilst we may have all the evidence, we need the back–up of resources from government or industry so that we can take the message to the people. From my experience the supermarkets are not going to lead this but will follow it if the incentive is right. We could make a start on by giving tax breaks on proportions of healthy food sold (all supermarkets have this data, it is only a matter of defining the list, and this has been done)4. It may be more productive than taxing ‘junk foods, ’ which manufacturers always seem to get around.
1 Lancet. 2006 Nov 11;368(9548):1673-9.Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M
Rapid Response:
Re: Should we screen for type 2 diabetes: Yes
It would seem sensible to act to prevent or certainly delay the onset of Type 2 diabetes and there is plenty of evidence from around the world to suggest that this can be achieved1. There is also some evidence of population-based prevention from Cuba from their desperate ‘special period’ in the early 1990’s2. Economic conditions due to the collapse of the Soviet Union forced serious food supply and energy problems on the country. The decline in incidence of heart disease (35%) and diabetes(51%) was put down to the increased exercise forced upon the peopleand decreased calorie intake.
Screening is only useful if an effective intervention is available for those identified . And from my experience, this is difficult. I ran a research project based on best practice weight management and lifestyle techniques combined with the comprehensive internet resources of a major UK supermarket diet programme(this was to try to get round the problem of lack of dieticians in the NHS)3. The results led on to collaboration between the supermarket and primary care. The patient paid for a reduced rate internet subscription and the GP was funded for participation, but only after that participation had happened and then pro rata for follow up. I wrote to all of our identified people with pre-diabetes states informing them of the potential prevention of their condition and that local treatment was available, be it the funded scheme or any other initiative. Out of 79 letters there was not one reply.
This is a small local example highlighting the problem of engagement. There seems little point in identifying your population if then the population does not necessarily want that intervention. Perhaps it is in the way you sell it but marketing and advertising at least to match the food industry may be needed. Whilst we may have all the evidence, we need the back–up of resources from government or industry so that we can take the message to the people. From my experience the supermarkets are not going to lead this but will follow it if the incentive is right. We could make a start on by giving tax breaks on proportions of healthy food sold (all supermarkets have this data, it is only a matter of defining the list, and this has been done)4. It may be more productive than taxing ‘junk foods, ’ which manufacturers always seem to get around.
1 Lancet. 2006 Nov 11;368(9548):1673-9.Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M
2http://www.ncbi.nlm.nih.gov/pubmed/17881386
3 http://gp.tescodiets.com/practitioners/
4 http://www.kent.ac.uk/cvcr
Competing interests: No competing interests