Prävention des Diabetes mellitus Typ 2

Zusammenfassung

Wir stehen nach wie vor - bedingt durch die Zunahme der Zahl von Patienten mit Diabetes mellitus Typ 2 (T2DM) - vor einem schwerwiegenden medizinischen, sozialen und ökonomischen Problem. Es ist daher dringend an der Zeit, Programme zur Primärprävention und zur gezielten Früherkennung des Diabetes mellitus zu entwickeln und umzusetzen. Mehrere große internationale Studien belegen, dass die Prävention des Diabetes mellitus durch Lebensstilveränderung bei Risikopersonen sowie einer frühen medikamentösen Intervention möglich und erfolgreich durchführbar ist. Primäres Ziel ist dabei die Stabilisierung und Verbesserung der Glukosetoleranz über eine Verbesserung der Insulinresistenz. Zielwerte zur Umsetzung entsprechender Programme können formuliert werden.

Angesichts der weltweit rasanten Diabetesepidemie müssen entscheidende Weichenstellungen erfolgen, um über eine Forcierung der primären, sekundären und tertiären Diabetesprävention schrittweise zu einem Nationalen Diabetespräventionsprogramm zu gelangen. Die Arbeitsgemeinschaft Prävention Typ 2-Diabetes der Deutschen Diabetes Gesellschaft hat gemeinsam mit der Deutschen Diabetes Stiftung ein Konzept für ein Nationales Präventionsprogramm vorgestellt. Zur Verwirklichung eines solchen Vorhabens sind viele Partner nötig, die sich in diesen Prozess einbringen. Die bevölkerungsweite Umsetzung der Diabetesprävention wird in Zukunft dabei in erster Linie auf einer Motivation zur Lebensstiländerung beruhen. Daneben wird die frühzeitige Pharmakoprävention des Diabetes zukünftig von wachsender Bedeutung sein.

Summary

Diabetes is one of the main threats to human health in this century. The drastic increase in incidence of diabetes worldwide has been attributed to distinct changes in human behaviour and lifestyle during the last century. To prevent the personal and socio-economic burden of diabetes effort to prevent the disease needs to start before the onset of diabetes and address all susceptibility factors. Four recent studies have shown that prevention of type 2 diabetes is possible and that reinforced lifestyle interventions/modification can significantly reduce the onset of the disease. The studies showed repeatedly that for about 60 % of the persons with increased diabetes risk, compared to a control group, the diabetes was prevented from developing. Early pharmacologic preventive strategies have yielded 25-30 %. This studies have convincingly demonstrated that the primary aim in prevention of type 2 diabetes is the stabilisation of glucose tolerance due to improvement of insulin resistance. Based on the studies intervention protocol focuses on achieving 5 core goals. With respect to the world wide burden of diabetes this studies offer a compelling evidence-base for the important translation of the research findings into community-based prevention strategies a development of a National Diabetes Prevention Program. The workgroup „Diabetes prevention” at the German Diabetes Association together with the Diabetes Foundation developed a concept for a National Programme. To realize this, a large number of partners are necessary. For the population based implementation of such a programme the intervention is primarily based on reinforced behaviour modification (lifestyle and physical activity). As add on the pharmako prevention of type 2 diabetes will be from increasing importance.

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Anschrift des Verfassers