Strategies and methods for implementing a community-based diabetes primary prevention program in Sweden

Non-insulin-dependent diabetes mellitus (NIDDM) is the most common type of diabetes with a prevalence of at least 4% in Sweden. There is convincing evidence that, besides a genetic predisposition, exogenous factors such as poor dietary habits (high fat, low fibre content), low physical activity and obesity are serious risk factors for NIDDM. Steps have been taken to develop a primary prevention program for NIDDM in Stockholm, Sweden. The program aims to reduce the incidence of NIDDM by 25% over a 10-year period, by influencing the risk factors in the populations of three intervention municipalities. The intervention will be developed through two approaches: 'community intervention', and 'intervention within community'. Evaluation of the program will be performed by monitoring the prevalence and incidence of diabetes in the target population and by assessing the effects of strategies designed to increase physical exercise and improve diet. Furthermore, changes in awareness, knowledge, attitudes and practices related to prevention of diabetes, will be investigated. For this purpose, a baseline study is carried out in the three intervention municipalities and two selected control municipalities. The baseline study includes a sample of about 3200 men and the same number of women, aged 35-54 years, from intervention and control populations. A follow-up study after 5 and 10 years will be made.