Public Health Intervention in Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus is a problem for society. According to a research done in 2002, type 2 diabetes mellitus and its related complication contributed to increase of health care cost of 368 pounds per capita per year in the United Kingdom.  In a survey done in 1996, it was found that approximately 2.9 million peoples have type 2 Diabetes Mellitus. It is predicted that this prevalence will increase to 5 million people if no intervention were to be done. Prompt and accurate interventions must be done to prevent people in getting type 2 diabetes mellitus. There are two different approaches in tackling type 2 diabetes mellitus problems: high-risk individual intervention and population based intervention. First, we will discuss each of the intervention, give examples on each type of intervention and finally discusses the difference of these two interventions.
High risk individual intervention is a strategy that involve identification of high risk individual in the population and making a tailor-made intervention for the individuals considered as having high-risk. This strategy is favored by many as it is considered more “on-target” and appropriate for the individuals. Many also believes that population enrolled in this strategy have higher motivation, as they are the one who have high risk of having a disease if no intervention were done.
One of the examples of high risk population interventions is a study that were done in Denmark. In this study, researchers identify from the population that have high risk in having type 2 diabetes mellitus based on several factors: BMI, family history, age, total calories consumption and activity levels. Those who are identified as having high risk for having type 2 diabetes mellitus will be given intensive lifestyle intervention. Lifestyle intervention includes nutritional coaching, sports activity and parental supervision. The result of this study shown that this intervention helped in reducing incidence of type 2 diabetes mellitus compared to the control group.
Many critics of this method believes that the effect of this high risk individual intervention is temporary at its best. The long-term effect of these type of interventions were unproven. The individual enrolled in this study must also deviate from his “norm” by enrolling in this study. For example, a patient decided to enroll in a study to reduce obesity level. He usually eats for 3200 calories in a day (higher than the recommended 2500 calories a day recommended by the government). For the purpose of this study, he must cut the caloric consumption to 1700 calories a day. This is a problem, as the patient may relapse to their old way of life after the intervention ended.
Other type of intervention that were used to curb type 2 diabetes mellitus as a public health problem is a population based intervention. In this type of intervention, government would enact law/program that affect all of the population. This may cause a population wide decrease in the incidence of type 2 diabetes mellitus.
Example of population based intervention to decrease type 2 diabetes mellitus is the recent New York City proposal to ban large-soda. This approved proposal calls for ban on soda larger than 16oz. The rationale of this ban is large soda contains large sugar contain that may increase people risk to having obesity and type 2 diabetes mellitus. This proposal was approved by Mayor Bloomberg in September 2012 and currently is a law in New York City.
This type of intervention tries to address the “root” of the problem by changing how society works. In this case is how people see portion size in their everyday living. People tend to overeat/drink when given large portion of a drink/food. By forcing people to buy smaller size meal, people will be thinking “is the additional portion necessary?” before going to buy another round of soda.            Opponent of this type of intervention argues that this kind of ban is hard to accept. They believe that government should not regulate something that is their “personal decision to make”. This kind of population based strategy is also considered much harder to implement. For example, this proposal needs 2 years to be approved in New York City assembly.
Both of the approaches have their own strength and weakness. Population based intervention is considered to be more effective in addressing type 2 diabetes mellitus as a public health problem compared to high risk intervention approach. A simulation showed that this approach will reduce incidence of T2DM from 49.4 to 40 a year compared to 49.4 to 47 a year using high-risk intervention. However, changing the whole society is much harder compared to intervening into certain individuals who are already at risk in having type 2 DM.
In conclusion, both population based intervention and high risk individual interventions have their own strength and weakness. Public health policy maker should be aware of these 2 approaches in choosing the intervention that is most suitable for the population. Suitable public health approach may be the solution to the ravaging type 2 DM pandemic.