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Diabetes is now a health and socioeconomic problem of first magnitude that requires the utmost attention to establish prevention and control programs.
Current knowledge on genetic, pathophysiological and environmental factors lead us to early preventive intervention.
Primary and Secondary Prevention:
They deserve to be considered two strategies for primary prevention and secondary prevention
Primary prevention
Strategy or population to detect and act on environmental factors, socioeconomic and genetic susceptibility.
Strategy or to persons who are at increased risk or susceptibility for development of diabetes mellitus
Secondary prevention
It is a diagnosis and early treatment. The main purpose is to prevent relapse of patients in remission has occurred, and disease progression in those already irreversibly compromised.
Leading organizations advise against scanning technique to do the whole population and suggest a selection of populations with risk factors.
DM1: When diagnosing DM1 is estimated to beta cell destruction is such that only a 10% of its normal population. But before that stage clinical noted the existence of a stage characterized only by genetic predisposition, and only progresses to diabetes if the beta cell is injured, resulting in antiislotes antibodies (ICA), anti-insulin (IAA), antibodies against the protein 64KD and GAD (glutamic acid decarboxylase). Genetic studies of diabetes associated with the HLA haplotypes B8, B15, DR3 and DR4, with the absence of the amino acid aspartic acid at position 57 of DQ beta chain locus, or the presence of arginine in position 52 of alpha chain DQ locus. The intervention in this preclinical phase is of great interest. Despite the poor predictive value of genetic and immunological markers invalidate the use in population. The trend is to reduce the field of population research at risk, using among relatives of newly diagnosed patients. The basis for this type of prevention is to stop the autoimmune destruction of beta cells. There are sufficient arguments to justify this intervention, but for now must be done only in the context of controlled clinical trials supervised by the ethics committees. There have been studies with immunosuppressants such as cyclosporin A and azathioprine. In ICA-positive children has also been used nicotinamide. Recently it is considering preventive treatment in the preclinical phase with low-dose insulin, which appears to act by promoting beta cell rest.
DM2: The genetic basis of DM2 is fully accepted, and the influence it exerted on socio-environmental factors. In the natural history of DM2 can describe several stages:
Stage 1 or pre-diabetic: patients with genetic susceptibility have normal glucose tolerance (TNG), but show insulin resistance and fasting hyperinsulinemia. May be present obesity, hypertension and dyslipidemia.
Stage 2: characterized by an impaired glucose tolerance (IGT). Often at this stage the macroangiopathy resulting in excess mortality
Stage 3: established diabetes mellitus
The current trend as in DM2 is early intervention in preclinical stage to prevent the occurrence of late complications.
a) Population Strategy: Obviously, population levels, weight control, diet and physical activity program initially posed as first line of prevention. Physical activity increases insulin sensitivity and has a protective effect of DM2. However, decreasing the sensitivity increased saturated fat and lower dietary fiber. Within this program is necessary to control risk factors like hypertension, hyperlipidemia and macroangiopathy.
b) Strategy to exposed persons: Studies show that peripheral resistance to insulin action is an inherited defect that predicts the development of diabetes mellitus and detectable in first-degree relatives of diabetic patients, which have a TNG but have a genetic susceptibility . The oral glucose is the best test to measure the effectiveness of interventions to prevent diabetes mellitus, and these intervention studies should be performed in high-risk individuals with GAD.
Currently, besides the involvement in the habits of life, are using drugs that improve insulin resistance in the preclinical stage of T2DM, such as sulfonylureas, biguanides, glucosidase inhibitor, acarbose and new tiazolidinodionas: troglitazone, ciglitazona and pioglitazone. But as we discussed for this type of intervention DM1 should only be undertaken in the context of controlled clinical trials supervised by the ethics committees.
Tertiary prevention:
Preventing long term complications of diabetes
DM1: The study DCCT (Diabetes Control and Complications Trial) demonstrated the importance of intensive therapy and strict metabolic control in type 1 diabetes (DM1) to prevent or delay progression of microvascular complications.
DM2: In September 1998, the UKPDS (United Kingdon Prospective Diabetes Study) has reported its final results, and demonstrates the importance of glycemic control and blood pressure in the reduction of problems associated with diabetes, especially microvascular complications and diabetes-related mortality, also for type 2 diabetes mellitus. DM2 But bear in mind that are common risk factors, and macrovascular disease is the main problem, detected in 40% of patients and the diagnosis. Although it has been related to the presence of the disease cardiovacular with the degree of hyperglycemia has not been achieved yet to demonstrate that good glycemic control managed to avoid.
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prevention and ex strategies for diabetes mellitus/
Dr. José Manuel García López del Complexo Hospitalario Universitario de Santiago (CHUS), member of the Galician Society of Endocrinology has been honored with the Fellowship of New Technology Group of the Spanish Society of Diabetes.
