Hyperglycaemia, Pre-Diabetes and Diabesity: Can we Choose who to 'Fast-Track' into Diabetes Prevention?

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Abstract

Despite considerable global efforts the number of people diagnosed each year with type 2 diabetes (T2D) continues to increase, hindered by our inability to both clearly define and to identify those most at risk, and therefore in turn to prioritise public health initiatives for those who could most benefit from ‘fast-track’ prevention. T2D is a disease with its origins in poor diet and lifestyle with excess weight gain and adiposity as the primary cause, and hence prevention of weight gain and/or weight loss is a central tenet to any prevention program. Global numbers of overweight and obesity have been increasing steadily for the past few decades [1-3], with little sign of slowing, despite significant global efforts to halt the increase, with the World Health Organisation (WHO) estimating that almost 2 billion adults have a body mass index (BMI) of 25kg/m2 or above [4]. In parallel T2D is becoming increasingly common [5]. In 1994 approximately 100 million people globally were reported with T2D, which increased to 382 million in 2013, and now with a projected increase to 592 million over the next 20 years [6]. Those who have high levels of central adiposity are at particular risk of T2D, with abdominal obesity strongly associated with important changes in body composition including lipid infiltration into critical organs such as pancreas and liver [7]. WHO also estimates that up to 80% of heart disease, stroke and T2D could be prevented by eliminating risk factors resulting from an unhealthy lifestyle [8], resulting in significant improvement both to the individual and national health care systems. In the US alone the medical consequences of obesity have been estimated to be in excess of US $150billion each year [9].