PROCEDIMIENTO PARA LA RECEPCIÓN DE LAS OBRAS DE URBANIZACIÓN

IMPLEMENTATION OF DIABETES PREVENTION

The Development Programme for the Prevention and Care of Diabetes (DEHKO 2000- 2010) is Finland's national diabetes programme. It aims to prevent type 2 diabetes and dia- betes-related complications and to improve the quality of diabetes care and to support the self-care of people with diabetes. DEHKO constructs new action models for health care which are implemented throughout Finland. The programme is coordinated by the Finnish Diabetes Association, and KTL is one of the associated partners. DEHKO is the first na- tional programme in the world to also include and implement the prevention of type 2 diabe- tes. The implementation of the prevention programme, FIN-D2D, is carried out in five hospi- tal districts in Finland during the period 2003-2007. It comprises three concurrent strategies: 1) the population strategy covering the general population, 2) the high-risk strategy that is based on individual-oriented measures targeted at those at a particularly high risk of devel- oping T2D, and 3) the strategy of early diagnosis and management of T2D directed at per- sons with newly diagnosed T2D.

The Unit has been actively involved in the planning and implementation of both DEHKO and FIN-D2D. Furthermore, the main body of the prevention programme is built around the ex- periences from the Unit's research work on primary prevention of type 2 diabetes by lifestyle intervention (DPS), and screening for high risk of type 2 diabetes by the diabetes risk score (FINDRISC).

In addition to Finland's national diabetes prevention programme, the Unit is working closely with several local projects which are implementing methods of lifestyle interventions to pre- vent type 2 diabetes. These include a collaboration with the occupational health-care pro- vider of the main Finnish airline to screen all employees of the corporation for high diabetes risk and disturbances in glucose metabolism, and to provide lifestyle intervention for those at highest risk. The role of KTL in the project is to provide expertise on the intervention methods, and to evaluate the effectiveness of these activities. Similarly, the city of Turku has a development project in association with several private and public occupational health-care providers aiming at the development of new methods for diabetes prevention implementation in occupational health care.

There is a clear consensus at the EU level that action is needed now to develop targeted prevention programmes for type 2 diabetes. Currently, numerous prevention management concepts exist in various European countries, and an evaluation of these is necessary in order to learn how the prevention of T2D works in reality and to find out the extent to which the prevention of T2D will reduce direct and indirect medical care and non-medical costs due to the disease. DE-PLAN (Diabetes in Europe - Prevention using Lifestyle, Physical Activity and Nutritional Intervention) project aims at addressing the development of national community-based T2D prevention programmes systematically throughout European coun- tries. IMAGE (Development and Implementation of a European Guideline and Training Standards for Diabetes Prevention) project will develop EU-wide intervention standards and strategies for diabetes prevention. The Unit is a collaborating partner in both of these EU-

funded projects, and has the responsibility of creating the standards for evaluation and qual- ity control of primary prevention of diabetes.

SCREENING FOR HIGH DIABETES RISK

The DPS and several other intervention studies have shown that T2D can be efficiently pre- vented by relatively simple and feasible lifestyle intervention. In most prevention trials par- ticipants with increased T2D risk were recruited based on elevated plasma glucose values especially after glucose load (impaired glucose tolerance). However, in health care setting, oral glucose tolerance testing to identify persons with high diabetes risk is not a feasible option. Therefore, a prediction model for future diabetes was developed using existing data sets from the FINRISK 1987 and FINRISK 1992 surveys. The end-point of the follow-up was the development of drug-treated diabetes. Baseline age, body mass index, waist cir- cumference, history of antihypertensive drug treatment and high blood glucose, physical activity and daily consumption of fruits, berries or vegetables were selected into the risk score model. The optimal cut-off point of the risk score identified 78% of those who got dia- betes during the follow-up (= sensitivity of the test) and 77% of those who remained free of diabetes (= specificity of the test). The final Finnish Diabetes Risk Score (FINDRISC) form includes, in addition to the predictors of the model, a question about family history of diabe- tes and the age category of over 64 years.

The use of FINDRISC to identify high-risk people, followed by lifestyle intervention, has been selected as the first line procedure in the Finnish national diabetes prevention pro- gramme, and is also used in several other diabetes-related projects in Finland, for example the GOAL (Good Ageing in Lahti Region; Ikihyvä Päijät-Häme). The FINDRISC has also been scientifically validated in Germany, Poland, and Italy, and serves as the risk screening tool in the European diabetes prevention project DE-PLAN. In addition, the FINDRISC is validated for screening of undiagnosed T2D, and it is being used for this purpose in several countries around the world.

Table 5.2. Summary table of committee memberships, coordination and proceedings with public health impact during 1997-2006.

Public health out-

put N Comments

Articles and reviews in non-peer-review jour- nals 41 TV, radio, newspa- per interviews 150 Membership in in- ternational committees with public health impact

15

e.g. WHO workshop group on Screening for Type 2 Diabetes; IDF Metabolic Syndrome Consensus Workshop; SNEHA - India working group for the improvement in health of women and young children; WHO/IDF Consultation: Definition and diagnosis of diabetes mellitus.

Membership in do- mestic committees with public health impact

15 e.g. National CVD and diabetes committee; Nutrition Guidelines for Diabetes working group; several committees in association with the Fin- nish national diabetes prevention programme.

Organization of in- ternational training with public health impact

16

e.g. 2nd Mediterranean Training Course on Epidemiology and Public Health Aspects of Diabetes; 2nd and 3rd Asian Pacific Diabetes Epidemiol- ogy Course; 3rd _{Advanced International Diabetes Epidemiology Course;} 3rd Diabetes and Cardiovascular Risk Factors - East Meets West Sympo- sium; 1st and 2nd International Reporting Days of the National Type 2 Diabetes Prevention Programme; European Stroke Master Course. Organization of do-

mestic training with public health impact

5