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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
Endocrinology and Metabolism Clinics of North America
Population-Level Approaches to Preventing Type 2 Diabetes Globally
Section snippets
Key points
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.
References (69)
- et al.
The Lancet Commission on diabetes: using data to transform diabetes care and patient lives
Lancet
(2020) Definition and classification of diabetes and prediabetes, and emerging data on phenotypes
Endocrinol Metab Clin
(2021)- et al.
Screening for diabetes and prediabetes
Endocrinol Metab Clin
(2021) - et al.
Prevention of Type 2 diabetes
Endocrinol Metab Clin
(2021) - et al.
Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study
Lancet Diabetes Endocrinol
(2014) - et al.
Preventing type 2 diabetes in communities across the U.S.: the National Diabetes Prevention Program
Am J Prev Med
(2013) - et al.
Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: findings from the Prospective Urban Rural Epidemiology (PURE) study
Lancet Glob Health
(2016) - et al.
The Short-Term Impacts of the Philadelphia Beverage Tax on Beverage Consumption
Am J Prev Med
(2018) - et al.
Financial incentives increase fruit and vegetable intake among Supplemental Nutrition Assistance Program participants: a randomized controlled trial of the USDA Healthy Incentives Pilot
Am J Clin Nutr
(2016) Insufficient Consumption of Fruits and Vegetables among Individuals 15 Years and Older in 28 Low- and Middle-Income Countries: What Can Be Done?
J Nutr
(2019)