Three patterns of rising type 2 diabetes prevalence in the world: need to widen the concept of prevention in individuals into control in the community.

This paper analyses the patterns of rising type 2 diabetes prevalence in the world with their plausible reasons focusing on control measures. It shows existence of combinations of three patterns of rises, viz. gradual, rapid and accelerated, leading to prevalence of 4-9% now in Europids, 14-20% in migrant or urbanized Asian Indians, Arabs, Chinese, Africans, and Hispanics and above 30-50% in indigenous peoples of Canada, USA, Australia and Pacific regions. It demonstrates that though ageing, sedentary life and obesity of people explain gradual rise in Europids, effects of rapid transition in nutritional status of population and of maternal hyperglycaemia on the risk of offspring developing glucose intolerance further add to rapid and accelerated rises respectively. It recommends that current approach of primary prevention of diabetes in people, particularly with impaired glucose tolerance, advocating modest loss of excess weight and moderate-intensity exercise, be widen into concept of control in community covering rapid and accelerated rises. The control programmes essentially are vigorous educational campaign and planning to improve nutritional status of women of childbearing age in rural and poorer sectors of society and to keep weight of adults within recommended body mass index (BMI) range, like 18.5-22.9 kg/m2 for Asian and other similar populations. The population-based approaches with examples, considering developing countries, are outlined. The paper emphasizes the importance of keeping prepregnancy weight optimum, preferably below the middle of recommended BMI range, to avoid even sub-clinical maternal hyperglycemia, for prevention and control of accelerated rise in any population.