Stratify risk, but don’t forget whole parts of the population.

Many experts spoke to the importance of using scientific understanding for better risk stratification. R. Keith Campbell, Professor Emeritus of Pharmacotherapy at Washington State University, spoke about the potential of genetic screening for diabetes susceptibility. Paul Zimmet, Professor of Diabetes at Monash University in Australia, and others spoke on the importance of epigenetics, or impacts of the prenatal environment on DNA. We also heard, at the 9th World Congress on the Prevention of Diabetes and its Complications, that we need to refine and strengthen our definition of prediabetes. After all, some people with prediabetes will never progress to type 2 diabetes, and we aren’t very good at predicting who will. More research needs to be done into the predictive efficacy of the various diagnostic tests for prediabetes, the applications of genetics to this process, and much more.

Prof. Zimmet also reminded us, however, that population-level prevention strategies are incomplete if they don’t also address lower-risk groups. He estimated that about half of type 2 diabetes cases come from populations that we consider to be at high-risk, while the other half comes from the general population. A comprehensive prevention effort needs both a community health component and a component specifically for those at the highest risk.