Opportunities for preventing diabetes and its cardiovascular complications

Als interventies gericht op verminderen van overgewicht en bevorderen van lichamelijke activiteit op landelijk schaal worden ingevoerd, zouden de komende 20 jaar 1 a 2% van de nieuwe gevallen van diabetes kunnen worden voorkomen. Daarnaast zouden de komende 20 jaar 5 a 10% van de nieuwe macrovasculaire complicaties bij mensen met diabetes kunnen worden voorkomen door intensievere behandeling. Preventie is essentieel om de toekomstige ziektelast van diabetes zoveel mogelijk te beperken. Van verschillende maatregelen is berekend in welke mate zij bijdragen aan het voorkomen van diabetes of diabetescomplicaties op de lange termijn. Daarnaast zijn voor deze maatregelen de kosten en kosteneffectiviteit geschat. Hierbij is gebruikgemaakt van een computermodel dat in staat is de ontwikkelingen van de Nederlandse bevolking, voor wat betreft risicofactoren, chronische ziekten en sterfte, te volgen over de tijd. Terugdringen van overgewicht is het belangrijkste wapen in het voorkomen van diabetes. Omdat met de bestaande interventies slechts een fractie van de mogelijke gezondheidswinst wordt gerealiseerd, moeten we blijven investeren in het identificeren en ontwikkelen van effectieve maatregelen om (blijvend) af te vallen. Stoppen met roken draagt niet bij aan preventie van diabetes maar wel aan preventie van andere chronische aandoeningen. Bij mensen met diabetes levert behandeling gericht op cholesterol- en bloeddrukverlaging een grotere bijdrage aan de preventie van macrovasculaire complicaties dan verder intensiveren van bloedsuikerbehandeling. Preventie van diabetes en diabetescomplicaties leidt tot hogere totale zorgkosten doordat mensen langer leven en zorgkosten maken in gewonnen levensjaren. Echter, voor alle bestudeerde maatregelen geldt dat de gezondheidswinst de extra kosten rechtvaardigt.

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