Skip to main content
SpringerLink
Log in

Prävention des Diabetes mellitus

Von der Idee zum nationalen Präventionsprogramm

Prevention of diabetes mellitus. From ideas to a national implementation program

  • Leitthema: Diabetes mellitus
  • Published:
Ernährung - Wissenschaft und Praxis

Zusammenfassung

Der beste Weg, Diabetes mellitus zu heilen ist, ihn zu verhindern. Mehrere große internationale Studien belegen, dass die Prävention des Diabetes mellitus und seiner Begleitkomplikationen erfolgreich durchführbar und kosteneffektiv ist. Danach haben Lebensstiländerungen oder frühe medikamentöse Interventionen bei 25–60% der Risikopersonen einen diabetespräventiven Effekt und reduzieren mit großer Wahrscheinlichkeit auch das kardiovaskuläre Risiko. Diese Studien bilden die Evidenzbasis, entscheidend aber ist die praktische und flächendeckende Umsetzung in Programme zur Diabetesprävention, anerkannt als Leistung der gesetzlichen Krankenkassen.

Die Realisierung eines solchen Vorhabens erfordert viele Partner, die interdisziplinär und berufsgruppenübergreifend kooperieren. Daher wurden unter der Schirmherrschaft des Nationalen Aktionsforums Diabetes mellitus (NAFDM) wesentliche Voraussetzungen für ein nationales Präventionsprogramm erarbeitet. Erforderlich ist die Implementierung einer Leitlinie zur Diabetesprävention, die Ziele und Standards für konkrete Interventionsmaßnahmen sowie Evaluationskriterien beinhaltet. Eine entscheidende Rolle kommt in diesem Konzept dem Präventionsmanager und einer prozessbegleitenden Qualitätskontrolle zu.

Die Implementierung strukturierter Präventionsmanagementprogramme ermöglicht eine flächendeckende Realisierung der Diabetesprävention, ohne das Gesundheitsbudget stark zu belasten. Sich der Herausforderung der Primärprävention zu stellen, erfordert die aktive Zusammenarbeit aller Partner und ist nur langfristig erfolgreich umzusetzen. Dies stellt allerdings ein lohnendes Investment für die Betroffenen, die klinische und wissenschaftliche Diabetologie und das Gesundheitswesen in Deutschland dar.

Abstract

The most efficient way to manage diabetes and its complications is to prevent the disease from developing. Recent studies have convincingly demonstrated that the prevention of diabetes and its complications are possible and cost-efficient. Lifestyle intervention and also early pharmacologic preventive strategies have yielded a 25–60% diabetes risk reduction and a promising reduction of cardiovascular risk. These findings offer the evidence base, however, the delivery of intervention and care is essential. The challenge, therefore, is the management of prevention and intervention programs considering scientific aspects and practical requirements during implementation. This can only be addressed in a coordinated interdisciplinary and cross-sector setting and requires the development of a comprehensive, integrated prevention management program. The implementation of a National Diabetes Prevention Program derived from evidence-based practical management guidelines is essential. Developing the role of the prevention manager and continuous evaluation and quality control are key factors in performing high quality intervention and care. Implementing managed prevention programs will enable nationwide prevention of diabetes mellitus without consuming a large amount of resources. This process will be challenging and time-consuming, requiring many partners but resulting in a profitable health investment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Schwarz PE et al. (2006) [Prevention of type 2 diabetes in Germany. Ideas-evidence-implementation.]. Med Klin 101: 730–736

    Article  Google Scholar 

  2. Knowler WC et al.(2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346: 393–403

    Article  PubMed  CAS  Google Scholar 

  3. Tuomilehto J. et al. (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344: 1343–1350

    Article  PubMed  CAS  Google Scholar 

  4. Chiasson JL et al. (2002) Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. PG - 2072–7. Lancet 359: 393–403

    Article  Google Scholar 

  5. Pan XR et al. (1997) Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 20: 537–544

    Article  PubMed  CAS  Google Scholar 

  6. Lindstrom J, Tuomilehto J (2003) The Diabetes Risk Score: A practical tool to predict type 2 diabetes risk. Diabetes Care 26: 725–731

    Article  PubMed  Google Scholar 

  7. Torgerson JS et al. (2004) XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 27: 155–161

    Article  PubMed  CAS  Google Scholar 

  8. Ramachandran A et al. (2006) The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 49: 289–297

    Article  PubMed  CAS  MathSciNet  Google Scholar 

  9. Valensi P et al. (2205) Pre-diabetes essential action: a European perspective. Diabetes Metab 31: 606–620

    Article  Google Scholar 

  10. Schwarz PE et al. (2006) Diabetes prevention – from physiology to implementation. Horm Metab Res 38: 460–464

    Article  PubMed  CAS  Google Scholar 

  11. Schneider H, Lischinski M, Jutzi E (1994) Die Diabetikerprognose im Nordosten Deutschlands. Z Arztl Fortbild (Jena) 88: 925–930

    CAS  Google Scholar 

  12. Narayan KM et al. (2003) Lifetime risk for diabetes mellitus in the United States. JAMA 290: 1884–1890

    Article  PubMed  CAS  Google Scholar 

  13. Hauner H (2005) Kostenaspekte des Diabetes in Deutschland. Dtsch Med Wochenschr (Suppl 2) 130: S64–S65

    Article  PubMed  Google Scholar 

  14. Haffner S, Taegtmeyer H (2003) Epidemic obesity and the metabolic syndrome. Circulation 108: 1541–1545

    Article  PubMed  Google Scholar 

  15. Zimmet P, Alberti KG, Shaw J (2001) Global and societal implications of the diabetes epidemic. Nature 414: 782–787

    Article  PubMed  ADS  CAS  Google Scholar 

  16. UK Prospective Diabetes Study Group (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. [see comments]. BMJ 317: 703–713

    Google Scholar 

  17. UK Prospective Diabetes Study Group (UKPDS) (1994) XI: Biochemical risk factors in type 2 diabetic patients at diagnosis compared with age-matched normal subjects. Diabet Med 11: 534–544

    Article  Google Scholar 

  18. Haffner SM et al. (2000) Insulin-resistant prediabetic subjects have more atherogenic risk factors than insulin-sensitive prediabetic subjects: implications for preventing coronary heart disease during the prediabetic state. Circulation 101: 975–980

    PubMed  CAS  Google Scholar 

  19. Fontbonne A et al. (1992) Body fat distribution and coronary heart disease mortality in subjects with impaired glucose tolerance or diabetes mellitus: the Paris Prospective Study, 15-year follow-up. Diabetologia 35: 464–468

    Article  PubMed  CAS  Google Scholar 

  20. Koster I, Hauner H, Ferber L von (2006) [Heterogeneity of costs of diabetic patients.]. Dtsch Med Wochenschr 131: 804–810

    Article  PubMed  CAS  Google Scholar 

  21. Ferber L von, Koster L, Hauner H (2006) [Costs of the treatment of hyperglycemia in patients with diabetes mellitus. The impact of age, type of therapy and complications: results of the German CoDiM study]. Med Klin 101: 384–393

    Article  Google Scholar 

  22. Fagot-Campagna A, Narayan KM, Imperatore G (2001) Type 2 diabetes in children. BMJ 322: 377–378

    Article  PubMed  CAS  Google Scholar 

  23. Diabetes Prevention Program Research Group (2003) Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Diabetes Care 26: 2518–2523

    Article  Google Scholar 

  24. Zimmet P, Shaw J, Alberti KG (2003) Preventing Type 2 diabetes and the dysmetabolic syndrome in the real world: a realistic view. Diabet Med 20: 693–702

    Article  PubMed  CAS  Google Scholar 

  25. Schwarz PE et al. (2007) Development of a diabetes prevention management program for clinical practice. Public Health Rep 122: 258–263

    PubMed  Google Scholar 

  26. Weber I, Brenner G, Schwarz P et al. (2005) Mehr Evidenz, breitere Akzeptanz, erhöhte Chancen auf Umsetzung einer Maßnahme zur Prävention des Typ- 2-Diabetes in Deutschland. Gesellschaft für Versicherungswissenschaft und -gestaltung e. V. Akademische Verlagsgesellschaft, Köln, 49: 239–244

  27. Hauner H et al. (2005) Prävention des Typ-2-Diabetes mellitus. Positionspapier des Nationalen Aktionsforums Diabetes mellitus. Dtsch Med Wochenschr 130: 1053–1054

    Article  PubMed  CAS  Google Scholar 

  28. Schwarz P et al. (2005) Prevention of type 2 diabetes: what challenges do we have to address. J Public Health 2: 296–303

    Google Scholar 

  29. Anderson KM et al. (1991) An updated coronary risk profile. A statement for health professionals. Circulation 83: 356–362

    PubMed  CAS  Google Scholar 

  30. Assmann G, Cullen P, Schulte H (2002) Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 105: 310–315

    Article  PubMed  Google Scholar 

  31. Saaristo T et al. (2005) Cross-sectional evaluation of the Finnish Diabetes Risk Score: a tool to identify undetected type 2 diabetes, abnormal glucose tolerance and metabolic syndrome. Diab Vasc Dis Res 2: 67–72

    Article  PubMed  Google Scholar 

  32. Silventoinen K et al. (2005) The validity of the Finnish Diabetes Risk Score for the prediction of the incidence of coronary heart disease and stroke, and total mortality. Eur J Cardiovasc Prev Rehabil 12: 451–458

    Article  PubMed  Google Scholar 

  33. Glumer C et al. (2004) A Danish diabetes risk score for targeted screening: the Inter99 study. Diabetes Care 27: 727–733

    Article  PubMed  Google Scholar 

  34. Schulze MB et al. (2007) An accurate risk score based on anthropometric, dietary, and lifestyle factors to predict the development of type 2 diabetes. Diabetes Care 30: 510–515

    Article  PubMed  Google Scholar 

  35. Schwarz P (2005) [Targeted diabetes prevention in high risk groups: pro]. Dtsch Med Wochenschr 130: 1103

    Article  PubMed  CAS  Google Scholar 

  36. Weyrich P et al. (85) Effect of genotype on success of lifestyle intervention in subjects at risk for type 2 diabetes. J Mol Med 85: 107–117

    Article  Google Scholar 

  37. Thamer C et al. (2007) High visceral fat mass and high liver fat are associated with resistance to lifestyle intervention. Obesity (Silver Spring) 15: 531–538

    Article  PubMed  Google Scholar 

  38. Stefan N et al. (2007) Genetic Variations in PPARD and PPARGC1A determine mitochondrial function and change in aerobic physical fitness and insulin sensitivity during lifestyle intervention. J Clin Endocrinol Metab

  39. Schwarz PE et al. (2006) Hypoadiponectinemia is associated with progression toward type 2 diabetes and genetic variation in the ADIPOQ gene promoter. Diabetes Care 29: 1645–1650

    Article  PubMed  CAS  Google Scholar 

  40. Schwarz PE et al. (2006) Haplotypes in the promoter region of the ADIPOQ gene are associated with increased diabetes risk in a german caucasian population. Horm Metab Res 38: 447–451

    Article  PubMed  CAS  Google Scholar 

  41. Schulze J et al. (2003) [Improvement of care for diabetics using the care model from Saxony]. Dtsch Med Wochenschr 128: 1161–1166

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Dresden

    P. E. H. Schwarz, J. Schulze & S. R. Bornstein

  2. Nationales Aktionsforum Diabetes mellitus, München

    P. E. H. Schwarz, U. Gruhl, J. Schulze, R. Landgraf & H. Hauner

  3. Else Kröner-Fresenius-Zentrum für Ernährungsmedizin der Technischen Universität München, München

    H. Hauner

  4. Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden

    P. E. H. Schwarz

Authors
  1. P. E. H. Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Gruhl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Schulze
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. R. Bornstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Landgraf
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Hauner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. E. H. Schwarz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schwarz, P.E.H., Gruhl, U., Schulze, J. et al. Prävention des Diabetes mellitus. Ernährung 1, 108–115 (2007). https://doi.org/10.1007/s12082-007-0028-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12082-007-0028-0

Schlüsselwörter

Keywords

Search

Navigation