Margarita E Matte and Emmanuel G Velonakis
Type 2 diabetes is the most costly chronic disease for both, the individual and the society. Many randomized controlled trials of structured lifestyle modification have consistently demonstrated that achieving and maintaining a healthy body weight through a combination of a change in dietary behaviors and an increase of physical activity reduces the risk of incidence of type 2 diabetes in adults at high risk. Although, their results have demonstrated the efficacy of lifestyle modification for diabetes prevention, long-term compliance with these lifestyle changes has proven difficult, however, and the benefits wane with weight regain. Small community-based programs have reported some success in modifying surrogate markers for diabetes through lifestyle intervention. The cost-effectiveness of lifestyle interventions has been examined in a number of clinical trials and computer modelling simulations. Short timehorizon studies have shown prediabetes lifestyle interventions to be cost-effective and even cost saving. Long timehorizon studies based on 10- to 30-year predictive mathematical models have used different models with different data, and have come to different conclusions about the cost-effectiveness of prediabetes lifestyle interventions. It is difficult to base a long time-horizon policy decision on predictive models when long-term randomized controlled trial data are not available to support the conclusions of those models. In conclusion, for large-scale implementation of preventive strategies, the future plan should focus on health education of the public, improving the national capacity to detect and manage non-communicable diseases and development of innovative, cost effective, and scalable methodologies.