The reality of type 2 diabetes prevention By Jaime Miranda | 02 Jul, 2014

Dear all, two recent publications deserve the attention and, possibly, careful scrutiny by this community.

Kahn R, Davidson MB. The reality of type 2 diabetes prevention. Diabetes Care. 2014;37:943-949.
"While the goal of diabetes prevention is extremely important, the absence of any persuasive evidence for the effectiveness of community programs calls into question whether the use of public funds or national prevention initiatives should be supported at this time"

Dunkley AJ, Bodicoat DH, Greaves CJ, et al. Diabetes prevention in the real world: effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations: a systematic review and meta-analysis. Diabetes Care. 2014;37:922-933.
"Objective: To summarize the evidence on effectiveness of translational diabetes prevention programs, based on promoting lifestyle change to prevent type 2 diabetes in real-world settings and to examine whether adherence to international guideline recommendations is associated with effectiveness."



Mohammed Ali Replied at 5:16 AM, 2 Jul 2014

Hi All,
This is Mohammed Ali (also known as Mo Ali) from Emory University in The US. Full disclosure: I have been an advisor for the US national diabetes prevention program rollout for the past few years.

My view presented here is brief and focused on the piece by Drs. Kahn and Davidson. I am all for skeptically evaluating the evidence and debating the merits of interventions, but I want to caution that readers should equally be skeptical of this commentary for the following reasons:
1. The authors cherry-pick studies and findings that support their case (that diabetes prevention is not an effective or cost-effective endeavor) - the literature is indeed mixed, but they present it as if it is one-sided;
2. Though it is true that behavior change is difficult to achieve and maintain, other pharmacological interventions to reduce CVD risk (which also require behavior change in terms of adhering to meds) have been held to lower expectations of evidence from efficacy studies (for those that don't know this literature, just as there are RCTs regarding use of statins or blood pressure lowering meds, there are highly cited and robust RCTs of diabetes prevention from at least 5 countries [DPS, DPP, da Qing, IDPP, Kosaka] and countless "translation" or "effectiveness" studies ongoing around the world); and
3. While it is easy to sit and criticize from a distance, the authors offer no alternative solution to address growing diabetes and prediabetes burdens in the US or globally. Their only offering is that we should change the environment, and to date, there is no conclusive evidence anywhere that building parks in cities or regulating specific foods/beverages will actually result in reduction of diabetes incidence. I would argue that these environmental changes are complementary to individual-focused diabetes prevention counseling.

There are many other arguments for and against diabetes prevention and I would encourage readers to remain mindful of: A. the burdens we face; B. the totality of evidence being debated; and C. how it all relates to your specific contexts.

Geneviève Bois Replied at 10:13 AM, 2 Jul 2014

Thanks for sharing Jaime, a very interesting read!

Jaime Miranda Replied at 1:57 PM, 2 Jul 2014

In addition to Mo's comment, I would add that what Kahn and Davidson understand by "community programs" is different from what other people, including me, may have in mind.

My intention in posting this was not to undermine current diabetes prevention efforts, but to have clear arguments, assorted and well elaborated, to refute those assertions.

Perhaps the YP community may want to reply to Diabetes Care and clarify, for the greater good, what is good and wrong about those opinions.