!Background: The prevalence and socioeconomic burden of type 2 diabetes (T2DM) and associated co-morbidities are rising worldwide. Aims: This guideline provides evidence-based recommendations for preventing T2DM. Methods: A European multidisciplinary consortium systematically reviewed the evidence on the effectiveness of screening and interventions for T2DM prevention using SIGN criteria. Results: Obesity and sedentary lifestyle are the main modifiable risk factors. Age and ethnicity are non-modifiable risk factors. Case-finding should follow a step-wise procedure using risk questionnaires and oral glucose tolerance testing. Persons with impaired glucose tolerance and/or fasting glucose are at high-risk and should be prioritized for intensive intervention. Interventions supporting lifestyle changes delay the onset of T2DM in high-risk adults (numberneeded-to-treat: 6.4 over 1.8-4.6 years). These should be supported by inter-sectoral strategies that create health promoting environments. Sustained body weight reduction by ≥ 5% lowers risk. Currently metformin, acarbose and orlistat can be considered as second-line prevention options. The population approach should use organized measures to raise awareness and change lifestyle with specific approaches for adolescents, minorities and disadvantaged people. Interventions promoting lifestyle changes are more effective if they target both diet and physical activity, mobilize social support, involve the planned use of established behaviour change techniques, and provide frequent contacts. Cost-effectiveness analysis should take a societal perspective. Conclusions: Prevention using lifestyle modifications in highrisk individuals is cost-effective and should be embedded in evaluated models of care. Effective prevention plans are predicated upon sustained government initiatives comprising advocacy, community support, fiscal and legislative changes, private sector engagement and continuous media communication.

Despite increasingly stringent clinical practice guidelines for glycaemic control, the implementation of recommendations has been disappointing, with over 60% of patients not reaching recommended glycaemic goals. As a result, current management of glycaemia falls significantly short of accepted treatment goals. The Global Partnership for Effective Diabetes Management has identified a number of major barriers that can prevent individuals from achieving their glycaemic targets. This article proposes 10 key practical recommendations to aid healthcare providers in overcoming these barriers and to enable a greater proportion of patients to achieve glycaemic goals. These include advice on targeting the underlying pathophysiology of type 2 diabetes, treating early and effectively with combination therapies, adopting a holistic, multidisciplinary approach and improving patient understanding of type 2 diabetes. Implementation of these recommendations should reduce the risk of diabetes-related complications, improve patient quality of life and impact more effectively on the increasing healthcare cost related to diabetes.

No abstract

The European Coalition for Diabetes (IDF Europe, FEND, PCDE and EURADIA) has once again joined forces to publish this fourth edition of the Policy Puzzle at a time when Europe is still faced with the growing epidemic of diabetes, despite considerable and increasing political awareness of the health risks of diabetes and the realisation that the disease is largely preventable. By presenting a review of the situation in Europe and how diabetes has evolved over the last 3 years, this fourth edition aims to monitor the evolution of the current epidemic and report on the national policies and practices that exist across 47 European countries. As well as providing evidence to policy makers and key stakeholders in diabetes about the epidemic and related policy frameworks, this comprehensive audit will provide evidence to improve the implementation of policies. BackgroundThere is no doubt about the extent of diabetes as a global public health concern. The 2013 IDF Diabetes Atlas estimates that 382 million adults worldwide have diabetes, a figure that is projected to increase to some 600 million by 2035. In Europe, there are 56.3 million adults living with diabetes and this is projected to reach nearly 70 million by 2035 -more than 10% of the total population of the wider European region.

No abstract