A
Determination of Diagnostic Criteria
In putting the high-risk strategy into effect, it is particularly important that the limit values used for both the diagnostic criteria of diabe-tes and the different levels of risk factors are clearly defined and based on research evi-dence.
A WHO expert group issued its recom-mendations on the diagnostic criteria for dia-betes in September 1999 (Table 1, page 8).
Implementing Prevention
In the high-risk strategy, the resources of the health-care system (and other relevant par-ties, such as private organizations) are direct-ed towards the risk groups with measures to enable the prevention of type 2 diabetes to be implemented. The reduction of risk factors (hypertension, abnormal lipid profile, over-weight, physical inactivity) in all population groups, further follow up of gestational dia-betes and effective health information are emphasized in particular. The specific objec-tives and measures are presented in Tables 9 and 10 on page 40.
Population Strategy
In Finland, it is highly likely that at least a third, if not half, of the population have genes that predispose them to type 2 diabetes. This means that in addition to the strategy targeted at people who are at high risk, measures aimed at the entire population are necessary.
The goals of the population strategy are to 1) influence health habits in such a way that
the risk factors of diabetes among people who are currently young or middle-aged do not change adversely over the years, or that the change is as small as possible 2) change the distribution of known risk
fac-tors in the older age groups in such a way that they are either reduced or at least do not increase.
The population strategy is based on promot-ing healthy lifestyles that are significant to the prevention of type 2 diabetes as well as other chronic diseases. This requires attitudinal sup-port from society through social norms and views within the community to encourage those measures that are implemented in the strategy targeted at the entire population.
Table 8.
Detecting individuals with a risk of type 2 diabetes
High risk individuals Detection
1. Relatives of people with type 2 diabetes Charting siblings and children
3. People with gestational diabetes Utilization of the blood glucose control records also after giving birth
4. Individuals with elevated blood pressure Determination of blood glucose and lipid levels at an early stage
5. Individuals with slightly elevated blood glucose Follow up and lifestyle counselling
6. Individuals with overweight or abdominal obesity Determination of blood glucose and lipid levels at an early stage
Table 9.
Objectives of prevention
Indication Objective
1. Age
• children
• young people
• elderly people
• prevention and treatment of overweight in children
• risk factors kept at a low level, eg target weight is the same as the person´s weight at 20–25 years of age
• reducing the increase of risk factors 2. Blood glucose values
• hyperglycemia and impaired glucose tolerance
• normal blood glucose values
• effective reduction of risk factors, assessment of the overall risk of cardiovascular diseases
• prevention of increase in risk factors, assessment of the overall risk of cardiovascular diseases 3. Cardiovascular risk factors • follow up of blood glucose, reduction of
existing cardiovascular risk factors, smoking cessation
4. Relatives of people with diabetes • dissemination of information, evaluation of diabetes risk with a score questionnaire 5. People with gestational diabetes • weight control, monitoring of blood glucose
• one year after giving birth: charting of family medical history, oral glucose tolerance test, blood pressure and blood lipid profile measures at the child welfare clinic or maternal health clinic
Table 10.
Action recommended according to follow up data
Indication Action
1. All values normal despite family medical history • oral glucose tolerance test, weight, blood lipid profile and blood pressure after five years or in connection with routine health check-ups 2. Levels normal, but BMI over 25 • individual follow up and lifestyle counselling
• tests at 2–5 year intervals
3. Oral glucose tolerance test result normal, but • referral to an appropriate care unit type 2 diabetes present in close relatives,
blood pressure and/or blood lipid values elevated
4. Diabetes present in close relatives, impaired • referral for diabetes care fasting glucose (IFG), impaired glucose tolerance
in oral glucose tolerance test or blood values meet diabetes criteria
F
Measures directed against smoking in the pre-vention of cancer and successful education on dietary adjustments in the prevention of cardi-ovascular diseases are worth mentioning as good examples of this kind of population strategy.
The same basic principles, objectives and recommendations that are listed in the Action Plan for Promoting Finnish Heart Health, set up by the Ministry of Social Affairs and Health and the Finnish Heart Association, are largely also applicable at the level of the gen-eral population for the prevention of type 2 diabetes. The action programme is the out-come of cooperative work among the various parties involved. Further broad cooperation is planned in the implementation phase. The Finnish Diabetes Association works in close cooperation with the Ministry of Social Af-fairs and Health and the Finnish Heart Asso-ciation in its own action programme.
Implementing Prevention
A strategy targeted at the whole population can be implemented through several different channels. It is essential that the majority of the population recognizes the extent and sig-nificance of diabetes as a public-health prob-lem and that general social and cultural norms are established in line with the objectives of prevention. However, simply distributing in-formation on health hazards and how to avoid them is not sufficient as a way of preventing chronic diseases.
The strategy requires special attention to be paid to the prevention of overweight and a marked increase in physical activity, as well as the promotion of healthy eating habits (see Chapter 7). Type 2 diabetes is a disease of slow onset, the prevalence of which increases with age. Its prevention therefore cannot be accomplished rapidly or with a single measure, and the activity must instead be methodical and sustained over a long period of time.