Risk Assessment of Future Type 2 Diabetes and Implication for Prevention

  • Pietro Amedeo Modesti
  • Maria Calabrese
  • Giorgio Galanti
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)


Nutrition and lifestyle transition seem to play a role in disclosing the predisposition for the development of type 2 diabetes in different populations with special regard to Asian and African countries. Great interest is now shown toward the possibility to intervene with lifestyle intervention on at-risk populations. The main question is: Who is to be considered at high risk? Subjects originating from South Asia, China, and Africa develop T2DM at a higher rate, at an earlier age, and at lower ranges of BMI than their European counterparts. Risk assessment of future type 2 diabetes is usually based on blood glucose levels, and prevention strategies are focused on high-risk subjects. However, when considering ethnic minorities which are known to have high prevalence of type 2 diabetes, limitations in the high-risk approach may be represented by low compliance at screening and follow-up and by the problematic contact with undocumented migrants. A new perspective for an approach specifically involving the whole communities can be considered. Health promotion, usually based on assumptions of a self-investment, should leave the approach to individuals when the aim is to involve societies with a collectivist history.


Type 2 diabetes Overweight and obesity Screening strategies Minority groups Ethnicity 


  1. 1.
    Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151–210.Google Scholar
  2. 2.
    Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211–59.Google Scholar
  3. 3.
    Atun R, Davies JI, Gale EAM, et al. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol. 2017;5(8):622–67.CrossRefGoogle Scholar
  4. 4.
    Hunter-Adams J, Yongsi BN, Dzasi K, et al. How to address non-communicable diseases in urban Africa. Lancet Diabetes Endocrinol. 2017;5(12):932–4.CrossRefGoogle Scholar
  5. 5.
    Collaboration NCDRF. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42.CrossRefGoogle Scholar
  6. 6.
    Petrelli A, Di Napoli A, Rossi A, et al. Overweight and obesity among adult immigrant populations resident in Italy. Epidemiol Prev. 2017;41(3–4 (Suppl 1)):26–32.PubMedGoogle Scholar
  7. 7.
    Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol. 2006;35(1):93–9.CrossRefGoogle Scholar
  8. 8.
    Ro A, Geronimus A, Bound J, et al. Cohort and duration patterns among Asian immigrants: comparing trends in obesity and self-rated health. Biodemography Soc Biol. 2015;61(1):65–80.CrossRefGoogle Scholar
  9. 9.
    Dijkshoorn H, Nierkens V, Nicolaou M. Risk groups for overweight and obesity among Turkish and Moroccan migrants in the Netherlands. Public Health. 2008;122(6):625–30.CrossRefGoogle Scholar
  10. 10.
    Antiporta DA, Smeeth L, Gilman RH, et al. Length of urban residence and obesity among within-country rural-to-urban Andean migrants. Public Health Nutr. 2016;19(7):1270–8.CrossRefGoogle Scholar
  11. 11.
    Wandell PE, Ponzer S, Johansson SE, et al. Country of birth and body mass index: a national study of 2,000 immigrants in Sweden. Eur J Epidemiol. 2004;19(11):1005–10.CrossRefGoogle Scholar
  12. 12.
    Kumar BN, Meyer HE, Wandel M, et al. Ethnic differences in obesity among immigrants from developing countries, in Oslo, Norway. Int J Obes. 2006;30(4):684–90.CrossRefGoogle Scholar
  13. 13.
    Choi JY. Prevalence of overweight and obesity among US immigrants: results of the 2003 new immigrant survey. J Immigr Minor Health. 2012;14(6):1112–8.CrossRefGoogle Scholar
  14. 14.
    Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.CrossRefGoogle Scholar
  15. 15.
    Ryden L, Grant PJ, Anker SD, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2013;34(39):3035–87.CrossRefGoogle Scholar
  16. 16.
    Sattar N, Gill JM. Type 2 diabetes in migrant south Asians: mechanisms, mitigation, and management. Lancet Diabetes Endocrinol. 2015;3(12):1004–16.CrossRefGoogle Scholar
  17. 17.
    Modesti PA, Galanti G, Cala’ P, et al. Lifestyle interventions in preventing new type 2 diabetes in Asian populations. Intern Emerg Med. 2015;11(3):375–84.CrossRefGoogle Scholar
  18. 18.
    Chiu M, Austin PC, Manuel DG, et al. Deriving ethnic-specific BMI cutoff points for assessing diabetes risk. Diabetes Care. 2011;34(8):1741–8.CrossRefGoogle Scholar
  19. 19.
    Yajnik CS, Lubree HG, Rege SS, et al. Adiposity and hyperinsulinemia in Indians are present at birth. J Clin Endocrinol Metab. 2002;87(12):5575–80.CrossRefGoogle Scholar
  20. 20.
    Carulli L, Rondinella S, Lombardini S, et al. Review article: diabetes, genetics and ethnicity. Aliment Pharmacol Ther. 2005;22:16–9.CrossRefGoogle Scholar
  21. 21.
    WHO. Appropriate body-mass index in Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9412):902.CrossRefGoogle Scholar
  22. 22.
    Bei-Fan Z, Working CMAG. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Asia Pac J Clin Nutr. 2002;11:S685–S93.CrossRefGoogle Scholar
  23. 23.
    Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163–70.PubMedGoogle Scholar
  24. 24.
    ADA. 2. Classification and diagnosis of diabetes. Diabetes Care. 2016;39(Suppl 1):S13–22.Google Scholar
  25. 25.
    National Institute for Health and Care Excellence. Assessing body mass index and waist circumference thresholds for intervening to prevent ill health and premature death among adults from black, Asian and other minority ethnic groups in the UK. Manchester: NICE; 2013. Accessed 7 Oct 2016.Google Scholar
  26. 26.
    Hsu WC, Araneta MRG, Kanaya AM, et al. BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care. 2015;38(1):150–8.CrossRefGoogle Scholar
  27. 27.
    Edelstein SL, Knowler WC, Bain RP, et al. Predictors of progression from impaired glucose tolerance to NIDDM—an analysis of six prospective studies. Diabetes. 1997;46(4):701–10.CrossRefGoogle Scholar
  28. 28.
    de Vegt F, Dekker JM, Jager A, et al. Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population—the Hoorn study. JAMA. 2001;285(16):2109–13.CrossRefGoogle Scholar
  29. 29.
    Gerstein HC, Santaguida P, Raina P, et al. Annual incidence and relative risk of diabetes in people with various categories of dysglycemia: a systematic overview and meta-analysis of prospective studies. Diabetes Res Clin Pract. 2007;78(3):305–12.CrossRefGoogle Scholar
  30. 30.
    Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults—the Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care. 1998;21(4):518–24.CrossRefGoogle Scholar
  31. 31.
    Modesti PA, Bianchi S, Borghi C, et al. Cardiovascular health in migrants: current status and issues for prevention. A collaborative multidisciplinary task force report. J Cardiovasc Med. 2014;15(9):683–92.CrossRefGoogle Scholar
  32. 32.
    American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care. 2013;36(Suppl 1):S11–66.CrossRefGoogle Scholar
  33. 33.
    Kengne AP, Beulens JWJ, Peelen LM, et al. Non-invasive risk scores for prediction of type 2 diabetes (EPIC-InterAct): a validation of existing models. Lancet Diabetes Endocrinol. 2014;2(1):19–29.CrossRefGoogle Scholar
  34. 34.
    Lindstrom J, Tuomilehto J. The diabetes risk score—a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725–31.CrossRefGoogle Scholar
  35. 35.
    Buijsse B, Simmons RK, Griffin SJ, et al. Risk assessment tools for identifying individuals at risk of developing type 2 diabetes. Epidemiol Rev. 2011;33(1):46–62.CrossRefGoogle Scholar
  36. 36.
    Collins GS, Mallett S, Omar O, et al. Developing risk prediction models for type 2 diabetes: a systematic review of methodology and reporting. BMC Med. 2011;9:103.CrossRefGoogle Scholar
  37. 37.
    Noble D, Mathur R, Dent T, et al. Risk models and scores for type 2 diabetes: systematic review. BMJ. 2011;343:d7163.CrossRefGoogle Scholar
  38. 38.
    Abbasi A, Peelen LM, Corpeleijn E, et al. Prediction models for risk of developing type 2 diabetes: systematic literature search and independent external validation study. BMJ. 2012;345:e5900.CrossRefGoogle Scholar
  39. 39.
    Schmidt MI, Duncan BB, Bang H, et al. Identifying individuals at high risk for diabetes—the atherosclerosis risk in communities study. Diabetes Care. 2005;28(8):2013–8.CrossRefGoogle Scholar
  40. 40.
    Hippisley-Cox J, Coupland C, Robson J, et al. Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore. BMJ. 2009;338:b880.CrossRefGoogle Scholar
  41. 41.
    Chen L, Magliano DJ, Balkau B, et al. AUSDRISK: an Australian type 2 diabetes risk assessment tool based on demographic, lifestyle and simple anthropometric measures. Med J Aust. 2010;192(4):197–202.PubMedGoogle Scholar
  42. 42.
    Rosella LC, Manuel DG, Burchill C, et al. A population-based risk algorithm for the development of diabetes: development and validation of the diabetes population risk tool (DPoRT). J Epidemiol Community Health. 2011;65(7):613–20.CrossRefGoogle Scholar
  43. 43.
    Mann DM, Bertoni AG, Shimbo D, et al. Comparative validity of 3 diabetes mellitus risk prediction scoring models in a multiethnic US cohort. Am J Epidemiol. 2010;171(9):980–8.CrossRefGoogle Scholar
  44. 44.
    Gillies CL, Lambert PC, Abrams KR, et al. Different strategies for screening and prevention of type 2 diabetes in adults: cost effectiveness analysis. BMJ. 2008;336(7654):1180.CrossRefGoogle Scholar
  45. 45.
    Admiraal WM, Vlaar EM, Nierkens V, et al. Intensive lifestyle intervention in general practice to prevent type 2 diabetes among 18 to 60-year-old south Asians: 1-year effects on the weight status and metabolic profile of participants in a randomized controlled trial. PLoS One. 2013;8(7):e68605.CrossRefGoogle Scholar
  46. 46.
    Latham K, Wu B. Chinese immigration into the EU: newtrends, dynamics and implications. 2013. p. 1–65.
  47. 47.
    Xu Y, Wang L, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA. 2013;310(9):948–59.CrossRefGoogle Scholar
  48. 48.
    Modesti PA, Calabrese M, Malandrino D, et al. New findings on type 2 diabetes in first-generation Chinese migrants settled in Italy: Chinese in Prato (CHIP) cross-sectional survey. Diabetes Metab Res Rev. 2016.Google Scholar
  49. 49.
    Modesti PA, Calabrese M, Malandrino D, et al. New findings on type 2 diabetes in first-generation Chinese migrants settled in Italy: Chinese in Prato (CHIP) cross-sectional survey. Diabetes Metab Res Rev. 2017;33(2).CrossRefGoogle Scholar
  50. 50.
    Modesti PA, Castellani S, Calabrese M, et al. Comparison of type 2 diabetes prevalence in Chinese migrants vs Caucasians and new perspectives for screening of cerebrovascular disease in Chinese: a proof of concept study. Diabetes Res Clin Pract. 2017;130:196–203.CrossRefGoogle Scholar
  51. 51.
    Stuart-Shor EM, Berra KA, Kamau MW, et al. Behavioral strategies for cardiovascular risk reduction in diverse and underserved racial/ethnic groups. Circulation. 2012;125(1):171–84.CrossRefGoogle Scholar
  52. 52.
    Artinian NT, Fletcher GF, Mozaffarian D, et al. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation. 2010;122(4):406–41.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Pietro Amedeo Modesti
    • 1
  • Maria Calabrese
    • 2
  • Giorgio Galanti
    • 1
  1. 1.Department of Clinical and Experimental MedicineUniversity of FlorenceFirenzeItaly
  2. 2.Diabetology UnitHospital “Misericordia e Dolce”, Azienda USL Toscana CentroPratoItaly

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