Population-Level Approaches to Preventing Type 2 Diabetes Globally

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Key points

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    Effective interventions at both the individual and population levels can help address type 2 diabetes (T2DM) prevention worldwide.

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    Individual-level risk factors for T2DM are rooted in society; population-level approaches aim to address the upstream societal drivers of unhealthy food consumption, physical inactivity levels, and obesity.

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    Population-level approaches to preventing T2DM include modifications to the food environment (pricing strategies, improvement of the food supply/availability, and

Population-level approaches to preventing type 2 diabetes

Population-level approaches aim to shift the distribution of a risk factor in a healthy direction, even if by a small degree, to significantly affect the proportion of individuals in a population who develop a disease.29 In the case of T2DM, population approaches can address the upstream societal drivers of unhealthy food consumption, physical inactivity levels, and obesity. Such approaches can be categorized broadly as (1) modifications to the food environment, (2) modifications to the built

Cost-effectiveness of population-level approaches to preventing type 2 diabetes

One of the most important considerations for policymakers is whether an intervention is cost-effective—that is, do the health and economic benefits of the intervention outweigh its cost? A recent systematic review of population-based approaches for T2DM prevention found evidence that these interventions are generally cost-saving or cost-effective. SSB taxes were found to be cost-saving from both health care system and government perspectives, with the potential to benefit a large population.

Importance of natural experiments in evaluating population-based approaches

While evidence for individual-level approaches to diabetes prevention comes from real-world trials and programs, what we know about the impact of population-level approaches often comes from simulation modeling (that estimates cost and effectiveness using numerous assumptions), due to ethical and practical issues of performing RCTs of such approaches, as well as the large sample sizes needed. For example, in the US, nutrition assistance programs such as SNAP and the Special Supplemental

Summary

The strongest evidence for T2DM prevention comes from RCTs in which people at high risk for T2DM have participated in a structured lifestyle intervention that addresses nutrition, physical activity, weight loss, and stress reduction and coping skills, but a growing body of evidence suggests that population-level approaches implemented alongside approaches for those at high risk have the potential to reduce T2DM risk in the general population. Population-level approaches include modifications to

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Disclosure

The authors have nothing to disclose.

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