Diabetes mellitus (type 2 diabetes, T2D) is one of the main threats to human health in this century.1 The drastic increase in incidence of diabetes worldwide has been attributed to distinct changes in human behavior and lifestyle during the last century, conditions collectively termed as the “metabolic syndrome.”2 Parallel with globalization, pronounced changes in the human environment and in human behavior and lifestyle have resulted in escalating rates of both obesity and diabetes.3 Diabetes mellitus today also means a significantly reduced life expectancy,4 reduced quality of life for the patient, and a significant burden for society due to increased health care cost.5 A recent large meta-analysis of population-based data shows that more than half of the European and probably the same or an even higher proportion of the Asian population will suffer from hyperglycaemia during their lifetime.6 Furthermore, diabetes and impairment of glucose tolerance are appearing increasingly in younger people, with a most sudden increase in the age group younger than 30 years.7 Unfortunately, people with diabetes are diagnosed in the professional medical system too late, often with a diagnose-free interval up to 15 years.8,9 This interval is the major metabolic burden for the disease, because during this time vascular and cellular lesions are set which will lead decades later to the severe disease-associated complications.10
The most efficient way to manage T2D is to prevent diabetes from developing. Also, complications of T2D can best be postponed by delaying the onset of the primary disease itself. The efforts to prevent the disease need to start as early as possible and address all susceptibility factors.11 Fortunately, recent studies have convincingly demonstrated that prevention of T2D is possible12–15 by showing that lifestyle intervention addressing diet and exercise reduces the risk of progressing from impaired glucose tolerance (IGT) to diabetes by 47% and 58%, respectively. Furthermore, it was shown that the drugs metformin,12 acarbose,14 and orlistat16 significantly decreased the progression from impaired glucose tolerance to diabetes.
While these findings offer the evidence base for the development of community-based prevention strategies,17 it is necessary to develop and implement prevention programs into clinical practice, considering scientific aspects and practical requirements during implementation.18 The study interventions followed a very intensive intervention program. There is a good chance that less intensive lifestyle programs are also effective in changing lifestyle.19 In this article, we present a diabetes prevention management concept which can be implemented in clinical practice.