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Diabetologie und Stoffwechsel 2020; 15(05): 377-391
DOI: 10.1055/a-0872-6365
CME-Fortbildung

Prävention, Remission oder Verzögerung der Typ-2-Diabetes-Manifestation – Teil 1

Prevention, Remission or Delay of the Manifestation of Type 2 Diabetes – Part 1
Rüdiger Landgraf
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Seit Langem fordern Mediziner und andere Gesundheitsfachkräfte mehr Anstrengungen für die Prävention chronischer Krankheiten – v. a. Adipositas und Typ-2-Diabetes (T2D). Im 2015 verabschiedeten Gesetz zur Stärkung der Gesundheitsförderung und der Prävention werden für den T2D zwar Ziele definiert. Es werden aber weder Strategien vorgestellt, noch finanzielle und personelle Voraussetzungen für eine wirksame Primär- und Sekundärprävention geschaffen.

Abstract

Prevalence and incidence of diabetes and especially type 2 diabetes are worldwide growing dramatically. In 2019 around 463 million people suffered from diabetes with an enormous increase to 700 million up to the year 2045. Realistic estimates report even a doubling of the prevalence when considering the undiagnosed cases. In Germany the prevalence of diabetes is around 10 %, of undiagnosed cases 2 % and of people with prediabetes (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] or both) 21 %. Diabetes and its complications account for at least 10–12 % of the total health expenditures in Germany. Prevention of type 2 diabetes together with other non-communicable diseases is therefore paramount to curtail this already existing health crisis. Drawing on the evidence from high quality randomized controlled trials, systematic reviews and meta-analyses lifestyle interventions are effective to prevent or delay the manifestation in high risk populations (i. e. prediabetes), which have to be identified by evaluated screening tools like the FINDRISK questionnaire and/or blood glucose parameters plus HbA1c. The strategies for a successful prevention are attacking multiple risk factors for the development of type 2 diabetes (f. e. obesity/fatty liver, physical inactivity, unhealthy eating and drinking including alcohol as well as coffee and tea consumption, smoking, sleeping disorders, depression) with non-pharmacological behavioural prevention which will be discussed in this evidence-based review (part 1 of this CME paper). Part 2 deals with important aspects of a setting-based/environmental prevention. Both behavioural and environmental prevention strategies have closely work together in order to achieve long-lasting successes in diabetes prevention.

Schlüsselwörter

Risikofaktoren - Typ-2-Diabetes - Verhaltensprävention - Verhältnisprävention

Key words

risk factors - type 2 diabetes - behavioural prevention - setting-based prevention


Publication History

Article published online:
27 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • Literatur

  • 1 International Diabetes Federation. IDF Diabetes Atlas. Brüssel: International Diabetes Federation; 2020 9th ed. 2019.
    Google Scholar
  • 2 Deutsche Diabetes Gesellschaft, diabetesDE-Deutsche Diabetes Hilfe, Hrsg. Deutscher Gesundheitsbericht Diabetes 2020. Bestandsaufnahme. Mainz: Kirchheim + Co GmbH; 2019
    PubMedGoogle Scholar
  • 3 Tönnies T, Röckl S, Hoyer A. et al. Projected number of people with diagnosed Type 2 diabetes in Germany in 2040. Diabet Med 2019; 36: 1217-1225
    CrossrefPubMedGoogle Scholar
  • 4 Heidemann C, Du Y, Paprott R. et al. Temporal changes in the prevalence of diagnosed diabetes, undiagnosed diabetes and prediabetes: findings from the German Health Interview and Examination Surveys in 1997–1999 and 2008–2011. Diabet Med 2016; 33: 1406-1414
    CrossrefPubMedGoogle Scholar
  • 5 Hoffmann R, Landgraf R, Hrsg. IMAGE – Development and Implementation of a European Guideline and Training Standards for Diabetes. Deutsche Fassung: Leitfaden Prävention Diabetes. 2011 Im Internet (Stand: 01.09.2020): http://www.diabetesstiftung.de/publikationen-und-broschueren
    PubMedGoogle Scholar
  • 6 Petersmann A, Müller-Wieland D, Müller UA. et al. Definition, Klassifikation und Diagnostik des Diabetes mellitus. Diabetologie 2019; 14: S111-S118
    Article in Thieme ConnectGoogle Scholar
  • 7 Landgraf R, Aberle J, Birkenfeld AL. et al. Therapie des Typ-2-Diabetes. Diabetologie 2019; 14 (Suppl. 02) S167-S187
    Article in Thieme ConnectGoogle Scholar
  • 8 Merlotti C, Morabito A, Pontiroli AE. Prevention of type 2 diabetes; a systematic review and meta-analysis of different intervention strategies. Diabetes Obes Metab 2014; 16: 719-727
    CrossrefPubMedGoogle Scholar
  • 9 Kerrison G, Gillis RB, Jiwani SI. et al. The effectiveness of lifestyle adaptation for the prevention of prediabetes in adults: A systematic review. J Diabetes Res 2017; 2017: 8493145
    CrossrefPubMedGoogle Scholar
  • 10 Glechner A, Keuchel L, Affengruber L. et al. Effects of lifestyle changes on adults with prediabetes: A systematic review and meta-analysis. Prim Care Diabetes 2018; 12: 393-408
    CrossrefPubMedGoogle Scholar
  • 11 Uusitupa M, Khan TA, Viguiliouk E. et al Prevention of type 2 diabetes by lifestyle changes: A systematic review and meta-analysis. Nutrients 2019; 1: 2611 . doi:10.3390/nu11112611
    CrossrefPubMedGoogle Scholar
  • 12 The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369: 145-154
    CrossrefPubMedGoogle Scholar
  • 13 The Look AHEAD Research Group. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2016; 4: 913-921
    CrossrefPubMedGoogle Scholar
  • 14 Lean MEJ, Leslie WS, Barnes AC. et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 2019; 7: 344-355
    CrossrefPubMedGoogle Scholar
  • 15 Lindstrom J, Ilanne-Parikka P, Peltonen M. Finnish Diabetes Prevention Study Group. et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 2006; 368: 1673-1679
    CrossrefPubMedGoogle Scholar
  • 16 Cardona-Morrell M, Rychetnik L, Morrell SL. et al. Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis. BMC Public Health 2010; 10: 653
    CrossrefPubMedGoogle Scholar
  • 17 Dunkley AJ, Bodicoat DH, Greaves CJ. et al. Diabetes prevention in the real world: Effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations. A systematic review and meta-analysis. Diabetes Care 2014; 37: 922-933
    CrossrefPubMedGoogle Scholar
  • 18 Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol 2015; 3: 866-875
    CrossrefPubMedGoogle Scholar
  • 19 Gong Q, Zhang P, Wang J. Da Qing Diabetes Prevention Study Group. et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol 2019; 7: 452-461
    CrossrefPubMedGoogle Scholar
  • 20 Haw JS, Galaviz KI, Straus AN. et al. Long-term sustainability of diabetes prevention approaches. A systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med 2017; 177: 1808-1817
    CrossrefPubMedGoogle Scholar
  • 21 NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128,9 million children, adolescents, and adults. Lancet 2017; 390: 2627-2642
    CrossrefPubMedGoogle Scholar
  • 22 Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol 2019; 15: 288-298
    CrossrefPubMedGoogle Scholar
  • 23 Blüher M. Metabolically healthy obesity. Endocr Rev 2020; 41: 405-420
    CrossrefPubMedGoogle Scholar
  • 24 Schmid V, Wagner R, Sailer C. et al. Non-alcoholic fatty liver disease and impaired proinsulin conversion as newly identified predictors of the long-term non-response to a lifestyle intervention for diabetes prevention: results from the TULIP study. Diabetologia 2017; 60: 2341-2351
    CrossrefPubMedGoogle Scholar
  • 25 Mantovani A, Byrne CD, Bonora E. et al. Nonalcoholic fatty liver disease and risk of incident type 2 diabetes: A meta-analysis. Diabetes Care 2018; 41: 372-382
    CrossrefPubMedGoogle Scholar
  • 26 Stefan N, Häring HU, Cusi K. Non-alcoholic fatty liver disease: causes, diagnosis, cardiometabolic consequences, and treatment strategies. Lancet Diabetes Endocrinol 2019; 7: 313-324
    CrossrefPubMedGoogle Scholar
  • 27 The Global BMI Mortality Collaboration. Body-mass index and all-cause mortality: individual participant-data meta-analysis of 239 prospective studies in four continents. Lancet 2016; 388: 776-786
    CrossrefPubMedGoogle Scholar
  • 28 Singh AK, Singh R. Pharmacotherapy in obesity: a systematic review and meta-analysis of randomized controlled trials of anti-obesity drugs. Expert Rev Clin Pharmacol 2020; 13: 53-64 . doi:10.1080/17512433.2020.1698291
    CrossrefPubMedGoogle Scholar
  • 29 Madsen KS, Chi Y, Metzendorf MI. et al. Metformin for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus (Review). Cochrane Database Syst Rev 2019; 12: CD008558
    PubMedGoogle Scholar
  • 30 Gillies CL, Abrams KR, Lambert PC. et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ 2007; 334: 299
    CrossrefPubMedGoogle Scholar
  • 31 Hayoz C, Hermann T, Raptis DA. et al. Comparison of metabolic outcomes in patients undergoing laparoscopic roux-en-Y gastric bypass versus sleeve gastrectomy – a systematic review and meta-analysis of randomised controlled trials. Systematic review. Swiss Med Wkly 2018; 148: w14633
    CrossrefPubMedGoogle Scholar
  • 32 Tarp J, Støle AP, Blond K. et al. Cardiorespiratory fitness, muscular strength and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetologia 2019; 62: 1129-1142
    CrossrefPubMedGoogle Scholar
  • 33 Piercy KL, Troiano RP, Ballard RM. et al. The Physical Activity Guidelines for Americans. JAMA 2018; 320: 2020-2028
    CrossrefPubMedGoogle Scholar
  • 34 Healy GN, Winkler EAH, Owen N. et al. Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers. Eur Heart J 2015; 36: 2643-2649
    CrossrefPubMedGoogle Scholar
  • 35 Chu AHY, Ng SHX, Tan CS. et al. A systematic review and meta-analysis of workplace intervention strategies to reduce sedentary time in white-collar workers. Obes Rev 2016; 17: 467-481
    CrossrefPubMedGoogle Scholar
  • 36 Dai X, Zhai L, Chen Q. et al. Two-year supervised resistance training prevented diabetes incidence in people with prediabetes: a randomised control trial. Diabetes Metab Res Rev 2019; 35: e3143
    CrossrefPubMedGoogle Scholar
  • 37 Zanuso S, Sacchetti M, Sundberg CJ. et al. Exercise in type 2 diabetes: genetic, metabolic and neuromuscular adaptations. A review of the evidence. Br J Sports Med 2017; 51: 1533-1538
    CrossrefPubMedGoogle Scholar
  • 38 Esefeld K, Heinicke V, Kress S. et al. Diabetes, Sport und Bewegung. Diabetologie 2019; 14 (Suppl. 02) S214-S221
    Article in Thieme ConnectGoogle Scholar
  • 39 Ley SH, Hamdy O, Mohan V. et al. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 2014; 383: 1999-2007
    CrossrefPubMedGoogle Scholar
  • 40 Neuenschwander M, Ballon A, Weber KS. et al. Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies. BMJ 2019; 365: 2368
    CrossrefPubMedGoogle Scholar
  • 41 Neuenschwander M, Hoffmann G, Schwingshackl L. et al. Impact of different dietary approaches on blood lipid control in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Eur J Epidemiol 2019; 34: 837-852
    CrossrefPubMedGoogle Scholar
  • 42 Reynolds A, Mann J, Cummings J. et al. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 2019; 393: 434-445
    CrossrefPubMedGoogle Scholar
  • 43 Salas-Salvadó J, Bulló M, Estruch R. et al. Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann Intern Med 2014; 160: 1-10
    CrossrefPubMedGoogle Scholar
  • 44 Brouns F. Overweight and diabetes prevention: is a low-carbohydrate–high-fat diet recommendable?. Eur J Nutr 2018; 57: 1301-1312
    CrossrefPubMedGoogle Scholar
  • 45 Snorgaard O, Poulsen GM, Andersen HK. et al. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care 2017; 5: e000354
    CrossrefPubMedGoogle Scholar
  • 46 de Cabo R, Mattson MP. Effects of intermittent fasting on health, aging, and disease. N Engl J Med 2019; 381: 2541-2551
    CrossrefPubMedGoogle Scholar
  • 47 Sutton EF, Beyl R, Early KS. et al. Early time-restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell Metabolism 2018; 27: 1212-1221
    CrossrefPubMedGoogle Scholar
  • 48 Chiavaroli L, Viguiliouk E, Nishi SK. et al DASH dietary pattern and cardiometabolic outcomes: An umbrella review of systematic reviews and meta-analyses. Nutrients 2019; 11: 338 . doi:10.3390/nu11020338
    CrossrefPubMedGoogle Scholar
  • 49 Forouhi NG, Misra A, Mohan V. et al Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ 2018; 361: k2234 . doi:10.1136/bmj.k2234
    CrossrefPubMedGoogle Scholar
  • 50 Serra-Majema L, Roman-Vinasd B, Sanchez-Villegasa A. et al. Benefits of the Mediterranean diet: Epidemiological and molecular aspects. Mol Aspects Med 2019; 67: 1-55
    CrossrefPubMedGoogle Scholar
  • 51 Taylor R, Al-Mrabeh A, Sattar N. Understanding the mechanisms of reversal of type 2 diabetes. Lancet Diabetes Endocrinol 2019; 7: 726-736
    CrossrefPubMedGoogle Scholar
  • 52 Ballon A, Neuenschwander M, Schlesinger S. Breakfast skipping is associated with increased risk of type 2 diabetes among adults: A systematic review and meta-analysis of prospective cohort studies. J Nutr 2019; 149: 106-113
    CrossrefPubMedGoogle Scholar
  • 53 Knott C, Bell S, Britton A. Alcohol consumption and the risk of type 2 diabetes: A systematic review and dose-response meta-analysis of more than 1.9 million individuals from 38 observational studies. Diabetes Care 2015; 38: 1804-1812
    CrossrefPubMedGoogle Scholar
  • 54 Li XH, Yu FF, Zhou YH. et al. Association between alcohol consumption and the risk of incident type 2 diabetes: a systematic review and dose-response meta-analysis. Am J Clin Nutr 2016; 103: 818-829
    CrossrefPubMedGoogle Scholar
  • 55 Carlström M, Larsson SC. Coffee consumption and reduced risk of developing type 2 diabetes: a systematic review with meta-analysis. Nutr Rev 2018; 76: 395-417
    CrossrefPubMedGoogle Scholar
  • 56 Pan A, Wang Y, Talaei M. et al. Relation of active, passive, and quitting smoking with incident diabetes: a meta-analysis and systematic review. Lancet Diabetes Endocrinol 2015; 3: 958-967
    CrossrefPubMedGoogle Scholar
  • 57 Schmid SM, Hallschmid M, Schultes B. The metabolic burden of sleep loss. Lancet Diabetes Endocrinol 2015; 3: 52-62
    CrossrefPubMedGoogle Scholar
  • 58 Tan X, Chapman CD, Cedernaes J. et al. Association between long sleep duration and increased risk of obesity and type 2 diabetes: A review of possible mechanisms. Sleep Med Rev 2018; 40: 127-134
    CrossrefPubMedGoogle Scholar
  • 59 Muraki I, Wada H, Tanigawa T. Sleep apnea and type 2 diabetes. J Diabetes Investig 2018; 9: 991-997
    CrossrefPubMedGoogle Scholar
  • 60 Reutrakul S, Mokhlesi B. Obstructive sleep apnea and diabetes: a state of the art review. Chest 2017; 152: 1070-1086
    CrossrefPubMedGoogle Scholar
  • 61 Pugliese G, Barrea L, Laudisio D. et al. Sleep apnea, obesity, and disturbed glucose homeostasis: Epidemiologic evidence, biologic insights, and therapeutic strategies. Curr Obes Rep 2020; 9: 30-38
    CrossrefPubMedGoogle Scholar
  • 62 Kulzer B, Albus C, Herpertz S. et al. Psychosoziales und Diabetes (Teil 1 + 2) S2-Leitlinie Psychosoziales und Diabetes – Langfassung. Diabetologie 2013; 8: 198-242 + 2013; 8: 292–324
    Article in Thieme ConnectGoogle Scholar
  • 63 Farooqi A, Khunti K, Abner S. et al. Comorbid depression and risk of cardiac events and cardiac mortality in people with diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 156: 107816
    CrossrefPubMedGoogle Scholar
  • 64 Graham EA, Deschênesc SS, Khalilb MN. et al. Measures of depression and risk of type 2 diabetes: A systematic review and meta-analysis. J Affect Disord 2020; 265: 224-232
    CrossrefPubMedGoogle Scholar
  • 65 Salvi V, Grua I, Cerveri G. et al. The risk of new-onset diabetes in antidepressant users – A systematic review and meta-analysis. PLoS ONE 2017; 12: e0182088
    CrossrefPubMedGoogle Scholar
  • 66 Shan R, Sarkar S, Martin SS. Digital health technology and mobile devices for the management of diabetes mellitus: state of the art. Diabetologia 2019; 62: 877-887
    CrossrefPubMedGoogle Scholar
  • 67 Kulzer B, Kröger J. Digitale Prävention. In: Digitalisierungs- und Technologiereport Diabetes (D.U.T.). Im Internet (Stand: 02.09.2020): 2020 http://www.dut-report.de/2020/01/14/digitale-praevention/
    PubMedGoogle Scholar
  • 68 Hemmingsen B, Gimenez-Perez G, Mauricio D. et al. Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Cochrane Database Syst Rev 2017; 12: CD003054
    PubMedGoogle Scholar
  • 69 Schlesinger S, Neuenschwander M, Ballon A. et al. Adherence to healthy lifestyles and incidence of diabetes and mortality among individuals with diabetes: a systematic review and meta-analysis of prospective studies. J Epidemiol Community Health 2020; 74: 481-487
    CrossrefPubMedGoogle Scholar
  • 70 Kempf K, Altpeter B, Berger J. et al. Efficacy of the Telemedical Lifestyle intervention Program TeLiPro in advanced stages of type 2 diabetes: A randomized controlled trial. Diabetes Care 2017; 40: 863-871
    CrossrefPubMedGoogle Scholar