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---Editorial Writer Says that Now is the Time for Community Prevention Programs
Two studies look at issues in prevention of type 2 diabetes mellitus, a condition that affects millions of Americans. An editorial writer asks, isn't the time right to implement community-wide diabetes prevention programs?
New results from a large trial of heart disease prevention in men, the Multiple Risk Factor Intervention Trial (MRFIT), found that positive lifestyle changes lowered the risk of developing diabetes among nonsmokers, but did not affect smokers' risk (Article, p. 313). In this study, researchers followed a subgroup of 11,827 men with normal glucose levels at the beginning of the study. Researchers assigned participants to a program to change diet, stop smoking and increase physical activity, or to usual care. About the same percentage of both groups (11.5 percent of the intervention group and 10.8 percent of the usual care group) developed diabetes over a six-year follow-up period. However, among nonsmokers, those in the program were less likely to develop diabetes than those who received usual care.
A computer simulation used data from the Diabetes Prevention Program (DPP) and other published reports to determine the cost-effectiveness of the DPP interventions, which included an intensive diet and exercise program, taking the diabetes drug metformin, or a placebo intervention (Article, p. 323). Participants in the DPP had abnormal blood glucose levels, which is a known risk factor for developing diabetes. Researchers found that both the diet-exercise program and metformin therapy reduced risk of developing diabetes. The diet-exercise program would cost about $8,800 and metformin would cost about $29,000 per year of healthy life saved. Both are within the range that the United States is typically willing to pay for health care treatments. The diet-exercise program had a favorable cost-effectiveness profile at all adult ages, while the metformin was not cost-effective after age 65.
An editorial writer calls for community-wide diabetes prevention programs (Editorial, p. 381). "During the history of public health, many large public health problems and epidemics have been overcome by acting on much less evidence than we have today for preventing type 2 diabetes," the writer says.
Researchers examined 841 Alaska natives who had been vaccinated against hepatitis B virus (HBV) 15 years earlier (Article, p. 333). They found that 84 percent had protective antibodies and only three participants had become infected with HBV during the 10-15 year follow-up period. Previous research suggested that the vaccine protects against infection for up to 10 years. An editorial writer says that the decision to administer booster doses after 15 years would depend on whether the primary goal of the vaccinations is to control hepatitis B infection in early infancy through high rates of primary vaccination, as is the case in countries such as Taiwan, or to prevent new cases of acute hepatitis B more than 20 years after childhood vaccination (Editorial, p. 384).