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PLOS BLOGS Speaking of Medicine

Week 2 of the Special Issue on Preventing Diabetes

Associate Editor Tom McBride discusses the new research and commentary appearing in the second week of PLOS Medicine’s Special Issue on Preventing Diabetes.

Each week this July PLOS Medicine will be publishing new perspective and research articles for our Special Issue on Preventing Diabetes, selected with our Guest Editors for this issue, Professors Nicholas Wareham and William Herman. Read the week one summary here.

As the prevalence of type 2 diabetes continues to increase worldwide, policymakers are seeking the most efficient strategies for preventing diabetes across all populations. In the Perspective article Population Approaches to Prevention of Type 2 Diabetes, Martin White (University of Cambridge, United Kingdom) notes that while lifestyle interventions aimed at increasing healthy behaviors like exercise and appropriate diet among high-risk individuals have been successful and cost-effective in randomized controlled trials, scale-up of these programs will likely lead to drop-offs in effectiveness and could leave the most vulnerable populations behind. Difficulties with access, uptake, and adherence often make these interventions less effective among people with socioeconomically disadvantaged backgrounds, and could thus widen inequities. Further, identifying high-risk individuals at the population level may not be cost-effective in low- and middle-income countries. An alternative to population screening and targeted interventions is implementing programs that incentivize and facilitate healthy behaviors in the population as a whole. Prof. White points to promising early findings following Mexico’s tax on sugar-sweetened beverages and after infrastructure improvements to encourage active commuting in the United Kingdom; however, he notes challenges to evaluating and comparing the real-world impact of population-level preventive interventions.

A cohort analysis by Matthew O’Brien (Northwestern University, United States) and colleagues demonstrates shortcomings of a recent effort to identify high-risk patients for targeted interventions. O’Brien and colleagues assessed of the effectiveness of the United States Preventative Services Task Force (USPSTF) recommendation to test overweight or obese adults between age 40 and 70 for dysglycemia (prediabetes or diabetes). When the researchers examined the electronic health records for 50,515 adult patients in the Midwest and Southwest US, they found that only 12,679 patients fulfilled the USPSTF criteria for screening, but of the patients who developed dysglycemia during the three-year follow up period, only 45% would have been identified by the USPSTF criteria. The screening criteria seemed particularly prone to misclassify black and Hispanic/Latino patients, groups that are more likely than white patients to develop dysglycemia at normal weight or before the age of 40.

In a retrospective analysis of the “Let’s Prevent Diabetes” Trial in the United Kingdom, Laura Gray and colleagues (University of Leicester, United Kingdom) looked for new information from a negative trial. Though the intervention, aimed at improving healthy behaviors and knowledge, showed no reduction in type 2 diabetes in the primary analysis of all enrolled participants, Dr. Gray and colleagues examined whether there was a benefit among the patients who were engaged and retained in the educational program. They found that attendance at all sessions was associated with an 88% reduction in type 2 diabetes incidence over three years compared to standard care, and that participants who did not engage with the intervention or attend all the sessions were younger and initially at higher risk of developing diabetes.

Finally, in a study that shows it’s never too late to pick up healthy habits, Martin Rasmussen (University of Southern Denmark) and colleagues examined whether habitual cycling, either as transportation to work or as recreation, is associated with lower risk of developing type 2 diabetes. The cohort study included 52,513 men and women from Denmark between the ages of 50 and 65, and found that participants who engaged in habitual cycling were less likely to develop T2D, and that risk of developing T2D appeared to decrease with longer time spent cycling per week. When participants were contacted again five years later and again asked to report their cycling habits, the researchers found that people who took up habitual cycling during this time were at 20% lower risk for T2D than non-cyclists. “We find it especially interesting that those who started cycling had a lower risk of type 2 diabetes,” says Rasmussen, “given that the study population were men and women of middle and old age. This emphasizes that even when entering elderly age, it is not too late to take up cycling to lower one’s risk of chronic disease.” In the accompanying Perspective article Cycling and Diabetes Prevention: Practice-Based Evidence for Public Health Action, Jenna Panter and David Ogilvie (University of Cambridge, United Kingdom) also noted the importance of encouraging people of all ages to take up healthy behaviors, and, like Martin White, call for support of research to evaluate population-level interventions designed to increase healthy habits.

Check back with PLOS Medicine each week in July for new research and commentary on diabetes prevention, and come to Speaking of Medicine for weekly updates. On July 27, join Special Issue Guest Editor Nick Wareham for his PLOS Science Wednesday AMA on redditscience (/r/science). He’ll be tackling the topic of preventing diabetes and answering questions about the Special Issue.

Tom McBride, PhD is an Associate Editor at PLOS Medicine.

Featured image credit: draganbrankovic, Flickr

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