Prevention needs to start before people develop prediabetes. Comprehensive interventions begin in childhood or even before birth

During our conversations, we asked people about their “dream” prevention program. In response, experts in a wide variety of fields consistently spoke about the need to focus on children, infants, and even prenatal factors. Numerous times, we were reminded that ultimately, the goal is not just to change the behavior of high-risk adults, but to raise children to have a lifetime of healthy behaviors. This is not to say that multigenerational involvement is not critical, but rather to point out that the only way to achieve and sustain population-level prevention is to consider future generations.

“Starting early” has multiple definitions. As Prof. Zimmet noted, “Governments aren’t paying enough attention to maternal and child health.” At the very least, the information that is collected is rarely applied to chronic disease prevention. Many others voiced the need to pay more attention to epigenetics, gestational diabetes, and other prenatal and infant factors. Many talked about the importance of nutritional and physical activity education for children, in the form of such things as school gardening, home economics and cooking classes in schools, physical education classes, health and nutritional education, and more. Others talked more broadly still about involving youth as leaders in prevention efforts to increase engagement and excitement. Youth buy-in and leadership are essential to sustain any youth-centered intervention—if kids aren’t interested it won’t stick. Dr. Paul Bloch, Senior Researcher and Team Leader at Steno Diabetes Center in Copenhagen, shared the story of a Danish project that asked teens to design neighborhood planning improvements using their skills with games like Minecraft and Lego. The effort led to successful neighborhood improvements and increased mutual respect between city planners and local youth.