!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.

No abstract

Objective: To compare the nutritional habits among six Mediterranean countries and also with the various official recommendations and the 'Mediterranean diet' as originally described. Design: Cross-sectional study. Settings: Three centres in Greece, two in Italy and one in Algeria, Bulgaria, Egypt and Yugoslavia. Subjects: Randomly selected non-diabetic subjects from the general population, of age 35 -60, not on diet for at least 3 months before the study. Interventions: A dietary questionnaire validated against the 3-Day Diet Diary was used. Demographic data were collected and anthropometrical measurements done. Results: All results were age adjusted. Energy intake varied in men, from 1825 kcal=day in Italy -Rome to 3322 kcal=day in Bulgaria and in women, from 1561 kcal=day in Italy -Rome to 2550 kcal=day in Algeria. Protein contribution (%) to the energy intake varied little, ranging from 13.4% in Greece to 18.5% in Italy -Rome, while fat ranged from 25.3% in Egypt to 40.2% in Bulgaria and carbohydrates from 41.5% in Bulgaria to 58.6% in Egypt. Fibre intake, g=1000 kcal, ranged from 6.8 in Bulgaria to 13.3 in Egypt and the ratio of plant to animal fat from 1.2 in Bulgaria to 2.8 in Greece. The proportion of subjects following the WHO and the Diabetes and Nutrition Study Group (DNSG) of the EASD recommendations for carbohydrates, fat and protein ranged from 4.2% in Bulgaria to 75.7% in Egypt. Comparison with the Mediterranean diet, as defined in the seven Country Study, showed significant differences especially for fruit, 123 -377 vs 464

The principal metabolic effect of metformin-an oral antihyperglycaemic agent-is the improvement in the sensitivity of peripheral tissues and liver to insulin. This study examined the effect of metformin monotherapy on antioxidative defence system activity in erythrocytes and plasma in diabetic patients. We studied the effect of metformin treatment on the activities of Cu, Zn-superoxide dismutase (EC 1. 15. 1. 1.), catalase (EC 1. 11. 1. 6.) and glutathione peroxidase (EC 1. 11. 1. 9.) in relation to lipid peroxidation products and reduced glutathione level in plasma and erythrocytes. In this study we also examined erythrocytes' susceptibility to H2O2-induced oxidative stress during metformin therapy. Although metformin monotherapy ameliorated the imbalance between free radical-induced increase in lipid peroxidation (by reducing the MDA level in both erythrocytes and plasma) and decreased plasma and cellular antioxidant defences (by increasing the erythrocyte activities of Cu, Zn, SOD, catalase and GSH level) and decreased erythrocyte susceptibility to oxidative stress, it had negligible effect to scavenge Fe ion-induced free radical generation in a phospholipid-liposome system.

Our results confirm the hypothesis that there is reduced antioxidative defense in type 2 diabetics with prominent cardiovascular complications, which negatively correlates with glucose concentrations and duration of diabetes and cardiovascular complications.

RESEARCH DESIGN AND METHODS -In the context of the Multinational MGSD Nutrition Study, three groups of subjects were studied: 204 subjects with recently diagnosed diabetes (RDM), 42 subjects with undiagnosed diabetes (UDM) (American Diabetes Association criteria-fasting plasma glucose [FPG] Ն126 mg/dl), and 55 subjects with impaired fasting glucose (IFG) (FPG Ն110 and Ͻ126 mg/dl). Each group was compared with a control group of nondiabetic subjects, matched one by one for center, sex, age, and BMI. Nutritional habits were evaluated by a dietary history method, validated against the 3-day diet diary. In RDM, the questionnaire referred to the nutritional habits before the diagnosis of diabetes. Demographic data were collected, and anthropometrical and biochemical measurements were taken.RESULTS -Compared with control subjects, RDM more frequently had a family history of diabetes (49.0 vs. 14.2%; P Ͻ 0.001), exercised less (exercise index 53.5 vs. 64.4; P Ͻ 0.01), and more frequently had sedentary professions (47.5 vs. 27.4%; P Ͻ 0.001). Carbohydrates contributed less to their energy intake (53.5 vs. 55.1%; P Ͻ 0.05), whereas total fat (30.2 Ϯ 0.5 vs. 27.8 Ϯ 0.5%; P Ͻ 0.001) and animal fat (12.2 Ϯ 0.3 vs. 10.8 Ϯ 0.3%; P Ͻ 0.01) contributed more and the plant-to-animal fat ratio was lower (1.5 Ϯ 0.1 vs. 1.8 Ϯ 0.1; P Ͻ 0.01). UDM more frequently had a family history of diabetes (38.1 vs. 19.0%; P Ͻ 0.05) and sedentary professions (58.5 vs. 34.1%; P Ͻ 0.05), carbohydrates contributed less to their energy intake (47.6 Ϯ 1.7 vs. 52.8 Ϯ 1.4%; P Ͻ 0.05), total fat (34.7 Ϯ 1.5 vs. 30.4 Ϯ 1.2%; P Ͻ 0.05) and animal fat (14.2 Ϯ 0.9 vs. 10.6 Ϯ 0.7%; P Ͻ 0.05) contributed more, and the plant-to-animal fat ratio was lower (1.6 Ϯ 0.2 vs. 2.3 Ϯ 0.4; P Ͻ 0.05). IFG differed only in the prevalence of family history of diabetes (32.7 vs. 16.4%; P Ͻ 0.05).

At the end of the study, RS-rich diet failed to affect glycaemic control in prediabetic obese individuals in contrast to the regular fibre-rich diet, which indicated that fibre profile could be an important determinant of the effect of dietary intervention.

No abstract