Who Should We Target for Diabetes Prevention and Diabetes Risk Reduction?
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Screening for individual diabetes risk is crucial to identify adult and pediatric high-risk target populations for referral into successful diabetes prevention programs. Determination of impaired glucose tolerance or elevated fasting glucose levels has been the “gold standard” to classify subjects at increased risk for and/or to diagnose type 2 diabetes (T2DM). However, this led to ignoring many individuals prone to develop the disease. Therefore, using a stepped strategy consisting of a preliminary assessment of risk factors, by using risk scores such as the Finnish Diabetes Risk Score (FINDRISC) adapted to the respective population, followed by a single blood test determining blood glucose or hemoglobin A1c, respectively, or an oral glucose tolerance test is a feasible and pragmatic method to more accurately detect individuals at risk for T2DM. Inclusion of further risk factors into the assessment such as physical inactivity, waist circumference, and prenatal factors needs to be thoroughly discussed to establish a valid and reliable stepped approach applicable to real world health care. This article provides an overview of the current literature and is intentionally focused on the identification of high-risk populations (both adult and pediatric) that will help to address the key issues around the prevention of T2DM in health care settings.
KeywordsType 2 diabetes mellitus Risk score Stepped risk strategy Diabetes risk factors Diabetes prevention
This work was supported by the European Commission AGREEMENT NUMBER–2006309, the Federal Ministry of Education and Research (BMBF), Germany (IFB AdiposityDiseases, FKZ: 01EO1001, to SB, JM, SH), by the Roland-Ernst-Stiftung für Gesundheitsforschung Dresden, Germany (SB), and by the Saxonian State Ministry of Social Affairs Dresden, Germany (to SB). We also would like to thank the Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig (Head: Prof. W. Kiess).
Conflicts of interest: S. Blüher: none; J. Markert: none; S. Herget: none; T. Yates: none; M. Davis: none; G. Müller: none; T. Waldow: none; P.E.H. Schwarz: none.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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