The epidemic of diabetes is spreading throughout the world. A large number of young people, and many more with diabetic complications of the eye, foot, kidney and heart will need healthcare in the near future. This will not only increase the clinical load on healthcare professionals but, more importantly, also have a serious social impact.

A lifelong treatment of diabetes is expensive.

Unfortunately, many diabetic patients do not take care of themselves until they develop serious complications such as heart attack, stroke or life-threatening infections. Many may require coronary by-pass surgery, dialysis or even amputation.

It is not correct to blame either the doctors or the patients for this because diabetes may go undiagnosed for years. The chronic complications of diabetes are irreversible. However, the silver lining is that they are preventable. In fact, diabetes itself can be prevented!

A number of primary prevention trials have convincingly demonstrated the feasibility of primary prevention of diabetes by lifestyle modification (LSM). There are two important challenges in this: First, the need to identify people who face a high risk of developing diabetes (pre-diabetes) and second, motivating people to adhere to lifestyle changes over a long period of time.

As both diabetes and pre-diabetes remain asymptomatic, the ideal way to diagnose is an oral glucose tolerance test with fasting and two-hour glucose values. However, the oral glucose tolerance test is cumbersome, time consuming and cannot be used to screen large numbers.

Another easy and cheap method to identify people at risk is to use the diabetes risk score, which is a validated, non-invasive method. For example, the risk factors of diabetes include family history of diabetes, overweight (BMI above 23), age above 35 years, higher waist circumference and sedentary lifestyle. If any two of these are present, the risk of diabetes can be considered high even without a blood test, and one can start working towards a better lifestyle.

Lifestyle modification does not mean big sacrifices. Studies have shown that even small changes — like walking for 30 minutes a day, avoiding sugar, sweets and fatty foods — have exceptional effects. For instance, avoiding one sweet a day (400 calories) helps reduce 14,600 calories in a year. Over a few years, this will have a cumulative effect resulting in substantial beneficial effects on body metabolism, leading to around 30 per cent risk reduction in development of diabetes.

As far as the strategies for LSM are concerned, pioneering research published in The Lancet this year has shown that text messages sent via mobile phones, can be used as a motivational strategy. In this landmark study, individuals who received text messages had better adherence to lifestyle and a 36 per cent reduction in incidence of diabetes over two years.

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