Natural History And Risk Factors For Type 2 Diabetes

Primary prevention of diabetes requires a thorough knowledge of the natural history of the development of glucose intolerance and risk factors. Once these have been established from observational studies, it is at least theoretically possible that interventions aimed at any of the factors could reduce diabetes risk. A number of recent reviews of risk factors exist8,31-39, and are summarized in Table 6.2 for individual level risk factors, that is, those that operate on or within a person. This table does not include group-, societal-, or populationlevel risk factors such as Westernization, commercialization of the food supply, increased motorized transport, television and computer time replacing group and individual activity and interaction, and changes in social mores which alter individual factors over large numbers of people simultaneously.

The information about possible genes related to or causing type 2 diabetes is not included here, since, in the short term, gene-based interventions are unlikely to be available. In the longer term, such approaches may prove feasible and may facilitate a more targeted prevention strategy. Table 6.2 does

Table 6.1. Summary of criteria to evaluate individual studies (1) and overall recommendations (2).

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