This meeting was hosted by the Diabetes Association of Sri Lanka and attended by Lifestyle changes in subjects with IGT decreases progression to diabetes. …
Consensus
on the
Aetiology of Type 2 Diabetes Mellitus
Preamble
A specially convened meeting under the banner of Diabetes In Asia was held
in Colombo, Sri Lanka on 6-7th July 2002 for the express purpose of
arriving at an aetiological consensus and the development of a primary
prevention strategy This meeting was hosted by the Diabetes Association of
Sri Lanka and attended by over 350 senior opinion leaders representing 30
countries worldwide
The panel of International experts presented the latest evidence on the
different aetiological factors, which was extensively discussed by all the
delegates present At the conclusion of these deliberations a Consensus was
reached on the Aetiology and Primary Prevention, which was submitted for
ratification by the International Diabetes Federation IDF and the World
Health Organisation WHO The faculty comprised the following experts: -
Chief Guest: - Prof Sir George Alberti - President - IDF
Guests of Honour:- Prof Pierre Lefèbvre - President Elect IDF
Prof Rhys Williams
- WHO
Moderators:- Prof Pierre Lefèbvre - President Elect of the
IDF
Prof Samad Shera - Hon Vice president - IDF
Chairpersons:- Prof John Turtle
Prof Clive Cockram
Prof George Chrousos
Prof Massimo Massi Benedetti
Prof Jean Claude Mbanya
Prof Hajera Mahtab
Prof David Phillips
Dr Linda Siminerio
Faculty:- Prof Graham Hitman
Prof Philippe Froguel
Prof Charles Nicholas Hales
Prof David Phillips
Prof C S Yajnik
Prof Martin Silink
Prof Kaichi Kida
Prof A Ramachandran
Prof George Chrousos
Dr Constantine Tsigos
Consensus Document
A consensus was reached on the Aetiology and Prevention of Type 2 Diabetes
Mellitus at the Diabetes In Asia 2002 meeting held on 6-7th July 2002 in
Colombo Sri Lanka
Proposition
Current Increase in the prevalence of Type 2 Diabetes Mellitus
worldwide - accepted with level A evidence
Increased incidence of Type 2 Diabetes Mellitus in Childhood and
Adolescence - Accepted with level A evidence
Genetics
Genetics is recognized as playing an important role in the
aetiopathogenesis of Diabetes Monogenic forms have been identified
Susceptibility genes have also been identified in the common forms of Type
2 Diabetes Mellitus Genetic studies have contributed to the discovery of
new pathogenic mechanisms
Accepted as a significant Aetiological factor- Level A evidence
Further studies need to be pursued
Genetic counseling not recommended at present
Foetal Origins
Epidemiological studies have reported a higher incidence of Type 2 Diabetes
Mellitus in subjects with a low birth weight The hypothesis that nutrition
of the mother can profoundly affect the metabolic outcome of the offspring
has been confirmed by elegant mechanistic animal studies
Low birth weight accepted as a significant aetiological factor - Level A
evidence
Poor nourishment of the foetus increases risk of metabolic syndrome
and Type 2 Diabetes Mellitus and
postnatal over-nutrition may
aggravate the syndrome
Animal studies are confirmatory Further clinical research in human
beings recommended
Life Style
There is a global epidemic of obesity affecting all ages Obesity is
associated with Insulin Resistance There is a strong association between
Obesity, Diabetes, Impaired Glucose Tolerance IGT and Cardiovascular
Disease CVD Physical inactivity is independently associated with
increased Insulin Resistance Lifestyle changes in subjects with IGT
decreases progression to diabetes
Accepted as a significant Aetiological factor level A evidence
Stress
Compelling animal evidence and Mechanistic studies suggest a relation
between stress and Insulin Resistance with predisposition to Type 2
Diabetes Mellitus
Accepted as an Aetiological factor Level B evidence
Further evaluation recommended
Primary Prevention
All of the above are likely to underline the urgent need for the Primary
Prevention of Type 2 Diabetes Mellitus and facilitate the introduction of
programmes, which must be tailored to local circumstances in order to be
effective
These should include lifestyle changes in all those at
risk
Concerted actions, including by governments, should be directed to the
following:
Increasing Awareness
Promotion of Education at all levels
Multi-sectoral Advocacy
Level A evidence - Indicates full acceptance
Level B evidence - Partial acceptance with more evidence needed
Source:diabetescamps.org
