Epidemiology of Diabetes -7

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  [MUSIC]We may ask the question.Which are the most important risk factors?We've already identified some risk factorsthat were related tothe characteristics of the populationgroups with different prevalence ofdiabetes.Clearly, where people live in the worldmatters,and can be considered a risk factoralthoughit is not so clear what is, thatproduces the differences in prevalencebetween the regions.However, to take the next steps inplanningprevention, we need to know whatdistinguishes thoseat risk of developing diabetes from thosenotat risk, or at lower risk within thepopulations.Let's see what the International DiabetesFederationlist as the most important risk factors.Family history of diabetes, overweight,unhealthy diet, physical inactivity,increasing age, high blood pressure,ethnicity, impaired glucose tolerance.History of gestational diabetes, and poornutrition during pregnancy.We have previous discussed ethnicity as animportant risk factor.With a particular high risk in people ofAsian srcin.As well as increasing age and gestationdiabetes asfactors associated with the increase riskof later diabetes.It should be mentioned that rather littleis known about the risk factors for type1 diabetes, the family history likelybasedon genetic pre-disposition, being the bestno one.So the lists is mainly encompassing riskfactors for diabetes type 2, andgestational diabetes.It is essential to understand that theseareall risk factors indicating increased riskfor thosewho exhibit or are exposed to them, butnone of them are inevitably leading todiabetes.Thus there may be people who do havethese risk factors, and who never developdiabetes.Moreover, you may encounter other risk  factors than those on the list.For example, smoking and new ones may bediscovered.For example specific variants in the DNA,and particular composition of the gutmicrobial flora.On the other hand, if all the known riskfactors already on the list are combined.They may explain much of the differencein risk of diabetes between people withinpopulations.When considering how to use the list ofrisk factors, we should carefully asseseach ofthem with respect to the possibility ofmodifyingthem, in the hope thereby to reduce therisk.Clearly several of them cannot bemodified.Family history, age, ethnicity history ofgestational diabetes, although thelatter by itself may be prevented in anearlier stage.However, even though they may not bemodified, they may help in identifyingpeople in whom it would be great benefitto modify those that can be modified.Such as, overweight, unhealthy diet,physicalinactivity, high blood pressure, impairedglucose tolerance,and, in relation to the risk ofgestational diabetes, also poor nutritionduring pregnancy.Impaired glucose tolerance is considered aclear marker of the early disease.Process by indicating that the disturbedglucose homeostasis is on its way.It presents when the blood glucose levelsare increased above normal level duringfasting, or following def, defined loadof glucose, given either orally orintravenously.Several large trials among suchindividuals have proven that it ispossible to prevent or at least delay thetransition to diabetes.Let's take a look at the key results fromone of these trials.This one here was conducted in Finland.Where people with impaired glucosetolerance were randomlyallocated to be in the control group, orin the group in which a healthy lifestyle,targeting the modifiable risk factors wasactively introduced.The x axis is the number of years afterthe randomization.The y axis is the cumulative probability  of remaining free of diabetes.The vertical bars are indicating thestatistical uncertainty.So called 95% confidence intervals.This probability, of course, starts at1.00 at the start of the trial.And you'll see that whereas only about 60%of the people in control remain freeof diabetes after six years, about 80%reach this goal in the intervention group.The difference between the two groups canbe expressed asa 60% reduction in risk of gettingdiabetes during this period.Other trials have produced similarly clearresult in lifestyle intervention.Which component in the lifestyleintervention is most importantmay depend on the characteristics of theindividuals beforehand.But increase in physical activity and amoderate weight loss seem to beparticularly important.The good news from these studies are thatitis feasible by improve the lifestyle todelay andpossibly even prevent diabetes when theindividual has enteredthe track, the impaired glucose toleranceleading towards diabetes.These results, of course generate theoptimism.About the possibility of prevention ofdiabetes inthe general population without screeningthem for impairedglucose tolerance.
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