In a decade’s time (1991-2001), the diagnosis of self-reported diabetes increased 61% in the US (Mokdad et al, 2003) including a startling increase from 1990 to 1998 among people in their 30s (Mokdad et al, 2000). Accounting for roughly 95% of all diabetes, type 2 diabetes is associated with obesity and weight gain (Mokdad et al, 2001), which is also increased over the same time period. One projection is that the 11 million residents that have been diagnosed with diabetes will increase to 29 million in 2050 (Boyle et al, 2001). The escalating prevalence of type 2 diabetes portends serious consequences for the quality of life of those affected and their families and communities.
To stem the rising tide of diabetes, public health policies need to move upstream toward prevention or at least delay in the onset of type 2 diabetes. A number of scientific studies offer scientific evidence and new hope for curtailing the epidemic of type 2 diabetes with support for intensive lifestyle modification and modest weight loss as effective interventions among adults at high risk for developing type 2 diabetes (Diabetes Program Research Group, n.d.. Pan et al, 1997. Tuomilchto et al, 2001). The transitional state in the natural history of diabetes when impaired glucose tolerance (IGT), impaired fasting glucose, or both are present has recently become known as “pre-diabetes” which affects 12 million overweight Americans between the aged 45-74 years (Benjamin et al, 2003), also raising their risk for cardiovascular disease (American Diabetes Association, 2002). Detection of pre-diabetes is not a goal for most diabetes screening programs (Rolka et al, 2001), but the lengthy development period diabetes, coupled with the potential to prevent or delay the onset of type 2 diabetes, offers an opportunity for multifaceted prevention efforts.