Primordial prevention

There is an urgent need for strategies to prevent or at least slow down the emerging burden of diabetes apart from treating diabetes and associated complications. Prevention of diabetes and its complications is the urgent need of the hour. Prevention of diabetes can be done at every stage in the natural history of diabetes resulting in four levels of diabetes prevention.

Primordial prevention

Attempts to reduce the risk factors for diabetes, e.g., reducing or preventing obesity to reduce the future risk of diabetes or prevention of prediabetes stage.

Primary prevention

It targets people who are in the stage of prediabetes to prevent the onset of diabetes. All people with prediabetes should be regularly screened and encouraged to pursue a healthy lifestyle, including a healthy diet, adequate exercise and weight control in order to prevent diabetes.

Secondary prevention

It is to prevent the onset of complications associated with diabetes in those who have already developed diabetes. This can be achieved by having a good control over the blood sugar, blood pressure and lipid levels with the help of a healthy lifestyle and taking anti-hyperglycemic drugs as indicated.

Tertiary Prevention

It is to prevent end-stage complications in those who have already developed some complications of diabetes by limiting disability and initiating rehabilitation measures

Thus, primordial and primary prevention contribute most to the health of the whole population by preventing the onset of the disease and its risk factors, while secondary and tertiary prevention is focused on restoring the health of individuals with the disease.

Primordial and primary prevention of diabetes

At our Centre, the prevention of type 2 diabetes is undertaken by encouraging physical activity and reduction of overweight/obesity in adults and children. We regularly hold diabetes awareness sessions in the community for people with prediabetes or at a high risk of developing diabetes. The ‘Five Steps’ emphasised to delay or prevent diabetes include:

• increasing intake of a healthy diet
• increased physical activity
• maintaining ideal body weight
• reducing stress (meditation, exercise, counselling, time management etc.) and
• screening for diabetes at regular intervals

The value of healthy eating is also encouraged through increased intake of fruits and vegetables, use of right type of fat and whole grain cereals like wheat or rice or millets instead of polished or refined flour, which is very high in carbohydrate (and thus glycemic load) and also low in protein and fibre.

Secondary and tertiary prevention of diabetes

The devastating and debilitating nature of diabetes complications makes the clinicians look for prevention strategies specific to complications. Preventive approaches to diabetes complications at our Centre can be categorized into three levels, first the early approach where early detection and appropriate treatment are the cornerstones for delaying the onset of the diabetic complications. Once complications have set in, preventing progression of the same would form the second approach or the intermediate approach which is done by introducing specific drugs or intervention for combating complications. The third is the late approach where complications have reached a very critical stage and interventional procedures like surgery are done to prevent progression to end stages of the complications.