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We may ask the question.

Which are the most important risk factors?
We've already identified some risk factors
that were related to
the characteristics of the population
groups with different prevalence of
diabetes.
Clearly, where people live in the world
matters,
and can be considered a risk factor
although
it is not so clear what is, that
produces the differences in prevalence
between the regions.
However, to take the next steps in
planning
prevention, we need to know what
distinguishes those
at risk of developing diabetes from those
not
at risk, or at lower risk within the
populations.
Let's see what the International Diabetes
Federation
list 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 poor
nutrition during pregnancy.
We have previous discussed ethnicity as an
important risk factor.
With a particular high risk in people of
Asian origin.
As well as increasing age and gestation
diabetes as
factors associated with the increase risk
of later diabetes.
It should be mentioned that rather little
is known about the risk factors for type
1 diabetes, the family history likely
based
on genetic pre-disposition, being the best
no one.
So the lists is mainly encompassing risk
factors for diabetes type 2, and
gestational diabetes.
It is essential to understand that these
are
all risk factors indicating increased risk
for those
who exhibit or are exposed to them, but
none of them are inevitably leading to
diabetes.
Thus there may be people who do have
these risk factors, and who never develop
diabetes.
Moreover, you may encounter other risk

factors than those on the list.

For example, smoking and new ones may be
discovered.
For example specific variants in the DNA,
and particular composition of the gut
microbial flora.
On the other hand, if all the known risk
factors already on the list are combined.
They may explain much of the difference
in risk of diabetes between people within
populations.
When considering how to use the list of
risk factors, we should carefully asses
each of
them with respect to the possibility of
modifying
them, in the hope thereby to reduce the
risk.
Clearly several of them cannot be
modified.
Family history, age, ethnicity history of
gestational diabetes, although the
latter by itself may be prevented in an
earlier stage.
However, even though they may not be
modified, they may help in identifying
people in whom it would be great benefit
to modify those that can be modified.
Such as, overweight, unhealthy diet,
physical
inactivity, high blood pressure, impaired
glucose tolerance,
and, in relation to the risk of
gestational diabetes, also poor nutrition
during pregnancy.
Impaired glucose tolerance is considered a
clear marker of the early disease.
Process by indicating that the disturbed
glucose homeostasis is on its way.
It presents when the blood glucose levels
are increased above normal level during
fasting, or following def, defined load
of glucose, given either orally or
intravenously.
Several large trials among such
individuals have proven that it is
possible to prevent or at least delay the
transition to diabetes.
Let's take a look at the key results from
one of these trials.
This one here was conducted in Finland.
Where people with impaired glucose
tolerance were randomly
allocated to be in the control group, or
in the group in which a healthy lifestyle,
targeting the modifiable risk factors was
actively introduced.
The x axis is the number of years after
the randomization.
The y axis is the cumulative probability

of remaining free of diabetes.

The vertical bars are indicating the
statistical uncertainty.
So called 95% confidence intervals.
This probability, of course, starts at
1.00 at the start of the trial.
And you'll see that whereas only about 60%
of the people in control remain free
of diabetes after six years, about 80%
reach this goal in the intervention group.
The difference between the two groups can
be expressed as
a 60% reduction in risk of getting
diabetes during this period.
Other trials have produced similarly clear
result in lifestyle intervention.
Which component in the lifestyle
intervention is most important
may depend on the characteristics of the
individuals beforehand.
But increase in physical activity and a
moderate weight loss seem to be
particularly important.
The good news from these studies are that
it
is feasible by improve the lifestyle to
delay and
possibly even prevent diabetes when the
individual has entered
the track, the impaired glucose tolerance
leading towards diabetes.
These results, of course generate the
optimism.
About the possibility of prevention of
diabetes in
the general population without screening
them for impaired
glucose tolerance.