Public health strategies that aim to prevent adult weight gain in the whole population have the potential to prevent twice as many cases of type 2 diabetes as strategies that target individuals, new research has found.
Currently such programmes tend generally to target those at high risk of type 2 diabetes, such as people who are obese and have higher than normal blood glucose. While there is evidence to show that these programmes are effective for the individuals who are targeted, their potential to impact the prevalence of diabetes in the whole population is limited, it is suggested.
The researchers from the University of Cambridge in England and Umea University in Sweden found a lack of evidence concerning the impact of moderate weight loss or weight maintenance in adults across the whole population on the occurrence of type 2 diabetes.
Their study sought to determine the potential to reduce the occurrence of diabetes of strategies that aim to shift the distribution of body weight in the whole population. It looked at data from 33,184 people aged 30 to 60 years who attended two health examinations 10 years apart between 1990 and 2013.
By analysing these data they were able to determine the association between change in body weight between baseline and 10 year follow-up and occurrence of newly diagnosed diabetes at 10 year follow-up, and assessed the impact of population-level shifts in body weight on the occurrence of diabetes.
In their analysis they made adjustments for potential confounding factors, including sex, age, calendar year, family history of diabetes, tobacco use, education and marital status.
During 10 years of follow-up 1,087 or 3.3% if participants developed diabetes, some 17,876 or 53.9% gained more than 1 kg/m2 relative to their starting weight and 12,020 or 36.2% maintained their weight. Compared to those who maintained their weight, people who gained more than 1 kg/m2 had a 52% higher risk of diabetes.
The researchers estimated that if everyone who gained weight had maintained their weight, regardless of their starting weight one in five of all type 2 diabetes cases in the population could have been prevented.
By contrast the researchers estimated, based on previous research, that if everyone in the population at high risk of diabetes due to having a BMI over 30 kg/m2 was referred to a commercial weight management programme, only one in 10 type 2 diabetes cases could be prevented.
‘We have shown that a population based strategy that promotes prevention of weight gain in adulthood has the potential to prevent more than twice as many diabetes cases as a strategy that only promotes weight loss in obese individuals at high risk of diabetes,’ said Dr Adina Feldman, from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge.
‘Thus, when it comes to body weight and diabetes, from a public health perspective it would be advisable to consider both high risk and population based strategies for diabetes prevention,’ she added.
The researchers caution that the modelling estimates should be interpreted carefully as they represent outcomes under idealised conditions, but they are useful to contrast the potential impact of different diabetes prevention strategies.
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