Prevention of Type 2 Diabetes - Buch.de€¦ · Prevention of Type 2 Diabetes Mellitus in Children...
Transcript of Prevention of Type 2 Diabetes - Buch.de€¦ · Prevention of Type 2 Diabetes Mellitus in Children...
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Prevention of Type 2
Diabetes
Edited by
Dr Manfred Ganz, M.D.
Specialist Internal Medicine, Diabetologist (DDG)
Associate Professor of Medicine
Campus Biomedico, University of Rome, Italy
Innodata047085734X.jpg
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Prevention of Type 2
Diabetes
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Prevention of Type 2
Diabetes
Edited by
Dr Manfred Ganz, M.D.
Specialist Internal Medicine, Diabetologist (DDG)
Associate Professor of Medicine
Campus Biomedico, University of Rome, Italy
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Copyright # 2005 John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester,West Sussex PO19 8SQ, England
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Cover image provided by the International Diabetes Federation
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 0470 85733 1
Typeset in 10.5/13pt Times by Thomson Press (India) Limited, New DelhiPrinted and bound in Great Britain by Antony Rowe Ltd., Chippenham, WiltshireThis book is printed on acid-free paper responsibly manufactured from sustainable forestryin which at least two trees are planted for each one used for paper production.
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For my loving family: my wife Helmi
with Nicholas, Fabian, Simon, Angela,
our foster child Christina, my parents
Rosa-Maria and Josef for their lifelong support
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Contents
Foreword xiii
Preface xv
List of Contributors xvii
SECTION 1 THE DIABETES EPIDEMIC:DESCRIPTION OF THE PROBLEM 1
1 The Diabetes Epidemic; Genes and Environment Clashing 3Paul Zimmet, Adrian Cameron and Jonathan Shaw
Introduction 3
An Epidemiological Perspective 3
The Hidden Epidemic Impaired Glucose Tolerance and Impaired
Fasting Glycaemia 6
Glucose Intolerance and the Metabolic Syndrome 6
Globalization its Impact on Human Health 8
Type 2 Diabetes in Children and Adolescents 9
Prevention the Reality and the Challenge 10
References 10
2 Type 2 Diabetes Mellitus: Primary and Secondary PreventionThe Vision of the International Diabetes Federation 15Pierre Lefebvre
Introduction 15
Primary Prevention of Type 2 Diabetes Mellitus 16
Prevention of Complications of Type 2 Diabetes Mellitus 17
The Global Issue 18
References 19
3 Type 2 Diabetes Mellitus in Children and Adolescents 21Thomas Reinehr and Martin Wabitsch
Introduction 21
Pathophysiology of Type 2 Diabetes Mellitus in Children and Adolescents 22
Epidemiology of Type 2 Diabetes Mellitus in Children and Adolescents 23
Clinical Presentation of Type 2 Diabetes Mellitus in Children and Adolescents 25
Clinical Features of Caucasian Children with Type 2 Diabetes Mellitus 25
Differential Diagnosis of Type 2 Diabetes Mellitus in Children and Adolescents 27
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Diagnostic criteria of Type 2 Diabetes Mellitus in Children and Adolescents 29
Complications of Type 2 Diabetes Mellitus in Children and Adolescents 31
Screening for Type 2 Diabetes Mellitus in Children and Adolescents 33
Treatment of Type 2 Diabetes Mellitus in Children and Adolescents 34
Pharmacological Treatment of Type 2 Diabetes Mellitus
in Children and Adolescents 35
Monitoring and Treatment of Complications of Type 2 Diabetes Mellitus
in Children and Adolescents 37
Prevention of Type 2 Diabetes Mellitus in Children and Adolescents 37
Conclusions 38
References 38
SECTION 2 SCREENING FOR TYPE 2 DIABETES 41
4 Screening for Undiagnosed Diabetes:
Whom, Where, When and How 43Tim Kenealy, Bruce Arroll and Peter Muller
Undiagnosed Diabetes and Its Harms 43
The Rate of Undiagnosed Diabetes in New Zealand 43
Should We Screen for Diabetes? 45
Theory of Screening 48
Screening Theories are Difficult to Apply to Diabetes: Implications of the
Diagnostic Criteria for Screening Decisions 55
Current Recommendations, New Zealand and International 56
Current Practice in New Zealand 56
Studies of Practical Screening in New Zealand 57
Systematic Opportunistic Screening in General Practice 58
Who to Test: Which Groups are at Relatively High Risk? 59
How to Test: Specific Screening Tests and cut-off Values? 62
Screening Intervals 71
Difficulty Applying Recommendations to Individual Patients 71
Screening Algorithms for Asymptomatic People 72
Summary 72
References 73
5 Genetic Screening and Prevention of Type 2 Diabetes 81Paolo Pozzilli
Introduction 81
Lessons from Type 1 Diabetes for Genetic Screening 83
Methods for Early Prediction of Type 1 Diabetes and Prevention Strategies 84
Type 2 Diabetes: Where do We Stand as regards Genetic Screening 85
Genes that are Identified with a Predisposition to Type 2 Diabetes: the New Scene 86
How can We Track the Prediabetes Period using Genetic Markers? 87
Genetic Screening for MODY and Potential Preventive Strategy 88
Conclusion 90
Acknowledgements 91
References 91
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6 Screening Parameters and Techniques:
Limitations and Opportunities 93Knut Borch-Johnsen and Charlotte Glumer
The Epidemiology of Type 2 Diabetes 94
What is Screening and How do We Evaluate a Screening Test? 95
Screening Strategies 96
Who Should be Screened Targeted Screening Strategies Based on
Phenotypical Characteristics? 99
Limitations, Perspectives and Recommendation 99
References 101
7 Screening for Diabetes Mellitus the World Health
Organization Perspective 105Gojka Roglic, Rhys Williams and Stephen Colagiuri
Introduction 105
Formulating Policies on Screening for Type 2 Diabetes 109
Widening the Evidence Base 112
Implementing Policies on Screening for Type 2 Diabetes 117
Conclusions and Recommendations 117
References 120
SECTION 3 PREVENTION OF TYPE 2 DIABETES 125
8 Findings from Preventive Type 2 Diabetes Trials 127Markolf Hanefeld
The Common Soil Hypothesis a Rationale for Preventive Measures in
Subjects with IGT 128
Lifestyle Trials with Prevention of Diabetes as Primary Objective 130
Pharmacological Trials with Prevention of Diabetes as Primary Objective 132
Coronary Heart Disease Prevention Trials with Prevention of Diabetes
as the Secondary Objective 138
Studies for Primary Prevention of Diabetes in Progress 140
Is Impaired Glucose Tolerance (IGT) a Disease? 142
Who Should be Treated (and How)? 145
Do We Treat Type 2 Diabetes too Late? 146
References 147
9 A Paradigm Shift is Needed in the Primary Prevention
of Type 2 Diabetes 153Jaakko Tuomilehto
Primary Prevention of Type 2 Diabetes the Current Paradigm 153
Re-Defining the Paradigm of Primary Prevention of Type 2 Diabetes 155
New Paradigm A Population Approach for Prevention of Type 2 Diabetes 155
New Paradigm Who is at High Risk? 156
New Paradigm True Primary Prevention: Targeting People Before
Their Blood Glucose Values are Abnormal 158
CONTENTS ix
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New Paradigm Prevention of Complications of Type 2 Diabetes
by Preventing Type 2 Diabetes Itself 159
New Paradigm How could Money for Diabetes Care be Allocated
in a More Efficient Way? 161
Comment 162
References 165
10 The Behaviour Change Process 169Frank J. Snoek and Richard R. Rubin
Introduction 169
Readiness to Change 170
Goal Setting 172
Supporting Behaviour Change 172
Changes and Maintenance 173
Implications 175
References 176
SECTION 4 PREVENTION OF COMPLICATIONSOF TYPE 2 DIABETES 179
11 Preventive Disease Management Risk Stratification
as a New Tool in the Hands of General Practitioners 181Thomas Konrad
Chronic Diseases, Health-Care Systems, Internet and Economic Burden:
From Intervention to Prevention 181
Basics of Preventive Medicine: Risk Stratification, Genetic
Testing and Information 183
Principles of Assessment of Risk Factors in Clinical Practice for
Cardiovascular Diseases and Diabetes Mellitus Type 2: Consequences
for the Individual Life 185
Preventive Disease Management for Diabetes Mellitus Type 2 and
Cardiovascular Diseases: Phenotyping the Early Detection of
Insulin Resistance and Endothelial Dysfunction 189
Integrative Preventive Care: Community-Based Strategy to
Avoid Chronic Diseases 193
Summary 197
References 198
12 Prevention of Obesity and Lipid Disorders 203Hermann Liebermeister
Reasons for Prevention 203
Problems in Prevention 212
Community-Based Prevention Studies 216
Promoting Physical Activity 218
Workside Interventions in Adults 220
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Specific Weight Gain Prevention Trials in Adults 220
Prevention of Diabetes and Obesity 222
Prevention of Lipid Disorders 227
Perspectives of Obesity and Dyslipidaemia Prevention 230
Acknowledgement 234
References 235
13 Renal Dysfunction and Hypertension, Focus on
Type 2 Diabetes 245Carl Erik Mogensen
Introduction 245
Historical Aspects 246
Evaluation of Diabetic Renal Disease and Classification 246
Diagnostic Procedures 249
Prevention 251
Treatment Strategy 252
Treatment in Overt Diabetic Renal Disease 255
Recent Treatment Guidelines for Patients with Diabetes Mellitus
with Focus on Hypertension 257
The Dual- or Triple- Jeopardy Concept 257
Goals for Blood Pressure 258
Old and Very New Guidelines 258
Screening for Microalbuminuria 259
Prevention and Intervention Related to Type 2 Diabetes 261
Summary 263
References 263
14 Diabetic Retinopathy in the 21st Century:
Screening and Visual Outcomes 271Ayad Al-Bermani and Roy Taylor
Introduction 271
Epidemiology 272
Good Glycaemic Control 272
Good Blood Pressure Control 272
Other Risk Factors 273
Screening 273
Effect of Screening Upon Rates of Blindness 277
Treatment of Diabetic Retinopathy 278
Panretinal Photocoagulation 278
Treatment of Macular Oedema 280
Vitrectomy 280
Summary 282
References 282
15 Prevention and Treatment of Diabetic Neuropathy 285Anders A. F. Sima
Introduction 285
Clinical Presentation and Classification of DPN 286
CONTENTS xi
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Pathogenetic Mechanisms 288
Tested Therapies 292
Future Therapeutic Opportunities 296
Concluding Thoughts 300
References 301
16 The Cardiologists View: Prevention of Macrovascular
Complications 313Michael Faust, Sabine Wiedenmann and Reinhard Griebenow
Prevalence of Cardiovascular Complications in Patients with Diabetes Mellitus 313
Occurrence of Diabetes in Patients with Cardiovascular Disease 315
Prognosis and Course of Coronary Heart Disease in Diabetic Patients 315
Explanatory Models for the Particular Fatal Course of Coronary Heart
Disease in Diabetic Patients (Risk Factors) 316
Cardiovascular Complications Preventive and Therapeutic Options 317
Interventional Revascularization 319
Procedure in Critical Ischaemia 320
References 320
17 Milestones and New Perspectives in Prevention of Type 2
Diabetes and its Complications 325Carl Erik Mogensen
Classification of Diabetes 325
Insulin Treatment with Focus on Euglycemia in Type 2 Diabetic Patients 327
Sulphonylurea (SU) Preparations 329
Metformin 330
Glitazones 330
The Metabolic Syndrome 331
Home Monitoring of Blood Glucose 331
Glycated Haemoglobin 332
Diabetes Nurses, Diabetes School and Dietary Help 332
Laser Treatment of Retinopathy, including Maculopathy, in Type 2 Diabetes 333
Diabetic Foot Care and Related Neuropathy 333
High Blood Pressure: Blood Pressure Lowering and Microalbuminuria 333
Lipid-Lowering Agents; Focus on Type 2 Diabetes 335
The Diet of Diabetic Patients 336
Multi-Factorial Intervention with Treatment Goals 336
Neuropathy 336
Conclusion 337
References 338
Index 343
xii CONTENTS
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Foreword
This book is centred on the prevention of the most common form of the condition,
Type 2 diabetes. It covers screening and primary prevention, as well as the
secondary prevention of the devastating complications of diabetes. Its perspective
is worldwide with contributions from experts drawn from across Europe, North
America and AsiaPacific.
I sincerely hope that this timely publication will attract not only the interest of
the physicians and scientists who form its primary audience, but also the attention
of health policy and decision makers working at national, regional and inter-
national levels, so that it can play a part towards advocating change, encouraging
action and promoting increased awareness of a condition that can be treated but
not as yet cured.
As stated elsewhere in this book, it is through the promotion of diabetes
prevention that the International Diabetes Federation (IDF) strives to ensure that
the millions who are living with diabetes today will not face a future decline in the
quality of their care as a result of the many more millions who are predicted to
develop the condition. At the same time, IDF is working to increase global access
to and bring about improvements in the quality of available care.
IDF has redefined its mission in order to reflect more closely the activity in
which it is involved and in particular to reflect the growing concern with the
prevention of diabetes that is influencing the activities of diabetes representative
organizations throughout the IDF membership network.
In line with our vision of living in a world without diabetes, the new mission of
the IDF is to promote diabetes care, prevention and a cure worldwide.
My deep hope is that through this book diabetes prevention receives a boost in
attention and activities among all the partners involved globally.
Although IDF does not support research directly, through awareness and
education it encourages the efforts of those who are working towards a better
understanding of the causes of the various forms of diabetes and ultimately
towards a cure.
As we often say at IDF, the time has come to act. . . NOW!
Pierre Lefebvre
President International Diabetes Federation