Public Health Nutrition: 13(6A), 993–999 doi:10.1017/S1368980010000960 Reducing the risk of type 2 diabetes with nutrition and physical activity – efficacy and implementation of lifestyle interventions in Finland Jaana Lindstro ¨m 1, *, Pilvikki Absetz 2 , Katri Hemio ¨ 1 , Pa ¨ivi Peltoma ¨ki 1 and Markku Peltonen 1 1 National Institute for Health and Welfare, Diabetes Prevention Unit, PO Box 30, FI-00271 Helsinki, Finland: 2 National Institute for Health and Welfare, Health Behaviour and Health Promotion Unit, Helsinki, Finland Submitted 20 July 2009: Accepted 15 March 2010 Abstract Background: The prevalence of type 2 diabetes has been increasing in Finland, in parallel with a gradual increase in overweight and obesity during the past decades. The expanding prevalence of type 2 diabetes brings along complica- tions, most importantly CVD. Therefore, it is extremely important to implement activities to prevent type 2 diabetes. Objective: In the present paper, the clinical evidence for the prevention of type 2 diabetes is presented with the Finnish diabetes prevention study. In addition, the paper discusses the practical implementation of prevention of type 2 diabetes using three different types of prevention programmes as examples: FIN-D2D, including risk-screening and repeated consultation in primary health-care; FINNAIR, a workplace-targeted intervention project involving airline employees; and the good ageing in Lahti region (GOAL) programme, a community-based prevention programme. Conclusions: FIN-D2D, the FINNAIR project and the GOAL programme have shown that screening for type 2 diabetes risk and implementing large-scale lifestyle inter- vention in primary health-care are feasible. However, the crucial questions still are whether it is possible to replicate the results concerning effectiveness of lifestyle intervention in primary and occupational health-care systems. Furthermore, it remains to be shown whether it is possible to achieve the same results in different health-care settings, cultures, regions and age groups, especially in adolescents and young adults among whom the increase in the incidence has been the highest. In addition, the importance of co-operation among all sections of society, citizens’ awareness of healthy lifestyles and the social inequalities in health must be emphasised because the diabetes epidemic cannot be solved only by concentrating on preventive actions carried out by health-care systems. Keywords Intervention Lifestyle Prevention Type 2 diabetes Despite the decrease in classical cardiovascular risk fac- tors as well as in cardiovascular morbidity and mortality in recent decades, the prevalence of type 2 diabetes has continued to increase in Finland. In 2008, over half a million Finnish people were estimated to have type 2 diabetes, half of them not yet aware that they have the disease (1) . The largest relative increase in drug-treated type 2 diabetes over the 12-year period from 1994 to 2006 was seen in the youngest age groups: among 15–29-year- olds the increase in prevalence was 9?5-fold, among 30–44-year-olds 3?3-fold, among 45–74-year-olds 85 % and among those over 75 years the increase was 48 % (2) . A study completed in young adults (aged 15–39 years) utilising several data sources revealed alarming results: although absolute incidence, and thus also the prevalence of type 2 diabetes among young adults was still low between 1992 and 1996 (11?8 cases per 100 000/year) the incidence increased on average by 7?9 % per year (3) . The most important lifestyle-related risk factors for type 2 diabetes are (abdominal) obesity, a sedentary lifestyle and a dietary pattern with high saturated fat, refined carbohydrate and total energy and low fibre content (4–7) . Beneficial changes in dietary composition, especially related to the intake of total and saturated fat, have occurred in Finland during the past decades. On the other hand, the increasing trend in the prevalence of obesity has persisted, indicating that in general, energy expen- diture on physical activity has decreased more than dietary energy intake. In 2007, in total 70 % of men and 57 % of women were overweight or obese (8) . Type 2 diabetes is a serious illness complicated by micro- and macro-vascular diseases such as, renal failure, *Corresponding author: Email jaana.lindstrom@thl.fi r The Authors 2010