Diabetes mellitus is a devastating disease affecting ~500 million people worldwide, and complications of diabetes are major causes of morbidity and mortality. Indeed, diabetes is the leading cause of cardiovascular disease, end-stage renal disease, blindness and non-traumatic lower-limb amputation. Diabetes-related costs are also huge, and this burden is expected to dramatically increase over the years as a result of several factors including the increasing incidence of diabetes, the increasing number and use of expensive glucose-lowering drugs and the need to treat diabetes-related complications requiring hospitalization.
As a chronic disease, diabetes has a long latency period, a protracted clinical course and no definitive cure. Therefore, the best way to tackle the global health emergency of diabetes is to prevent its onset. Effective prevention encompasses an updated knowledge of risk factors, an early recognition of pre-diabetic stages and prompt medical intervention. Obesity is the major risk factor for diabetes and its prevalence is increasing alongside and faster than diabetes prevalence. In the last decade, new approaches including both drugs and surgery are changing the landscape of obesity management. Pre-diabetic stages, including impaired fasting glucose levels and impaired glucose tolerance are highly prevalent: about 350 million people aged 20-79 years have pre-diabetes. However, the diagnosis of pre-diabetes is often missed. Ad-hoc screening programs are therefore needed, especially in developing countries, which have the highest rise in diabetes incidence.
Several randomized controlled trials of primary prevention have been conducted producing high quality evidence to support the effectiveness of lifestyle interventions and pharmacotherapy in stopping the path from pre-diabetes to overt diabetes. Eminent scientific societies have released crucial recommendations for diabetes prevention that should be routinely implemented in daily clinical practice.
