The prevalence of type 2 diabetes has increased dramatically in Europe, particularly in younger people. Nevertheless, jointly developed prevention strategies are still lacking. The development and Implementation of A European Guideline and training standards for diabetes prevention (IMAGE) project was initiated by the Technical University Dresden in response to this major public health concern of the European Union. Within the IMAGE project, four specific objectives will be developed and implemented into clinical practice: a) joint European guidelines; b) a European training curriculum for prevention managers; c) European standards for quality control of diabetes prevention programmes; and d) a European e-health training portal for prevention managers. This three-year-project began in June 2007. At the time of writing, 32 institutions from 16 countries have become involved. The development of competent guidelines and education programmes, as well as the establishment of quality standards for the primary prevention of type 2 diabetes, should significantly enhance the ability of healthcare professionals to respond swiftly to its drastic increase and its burden to society.

The dramatic increase in newly diagnosed cases of type 2 diabetes (T2D) has developed into a major public health concern worldwide. Conversely, several clinical studies have demonstrated that preventive efforts can significantly reduce the risk of developing diabetes. There is a clear consensus that action is needed to develop targeted community-based prevention programs and strategies for T2D. Currently, numerous prevention management concepts that can be implemented into clinical practice exist in various countries. Finland is the pioneer country in implementing community-wide diabetes prevention programs. Nevertheless, population-based nationwide strategies are still lacking in virtually all countries. We report on intervention strategies to prevent T2D in people with increased diabetes risk, as well as strategies on how to implement diabetes prevention programs into the real world of public health or clinical care. The implementation of managed prevention concepts will realistically help to improve the ability to prevent T2D in the public health framework.

One of the challenges in clinical diabetology today is to develop and implement diabetes prevention management programs for clinical practice. Recent studies have convincingly demonstrated that lifestyle intervention, addressing diet and exercise, as well as pharmacological preventive strategies reduce the risk of progressing from impaired glucose tolerance to diabetes. With respect to the worldwide burden of diabetes, these studies offer a compelling evidence base for the important translation of the research findings into community-based prevention strategies and the development of a national diabetes prevention program. The work group "diabetes prevention" of the German Diabetes Association together with the National Action Forum Diabetes and the German Diabetes Foundation developed a concept for a national program. This comprises a three-step intervention: in a first step individuals at high risk of developing type 2 diabetes are identified. The second step provides an intensive group intervention to prevent diabetes, and in a third step continuous intervention should facilitate motivation maintenance and evaluation. This third step is the crucial step to maintain the effect in changing lifestyle. Recently, a compendium for diabetes prevention was developed as a practical guideline explaining how to implement prevention programs. This guideline also includes the structure of a national prevention program with a prevention manager having a central role in the concept and suggestions for evaluation and quality control.

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