Interventions for primary prevention are crucial in tackling type 2 diabetes (T2D) by offering a structured approach to implementing lifestyle modifications, such as community-based programs. The aim of this study was to demonstrate the effectiveness of primary prevention interventions in preventing or delaying the onset of T2D in the 28 EU member states (EU-28). The present systematic review is registered on PROSPERO (CRD42020219994), and it followed the PRISMA guidelines. Eligibility criteria comprised original interventional studies reporting incidence of T2D in member states of the EU-28. A total of 23,437 records were initially retrieved, of which 16 met the eligibility criteria for inclusion. These interventional studies, published between 2003 and 2021, provided data from Spain, the UK, Finland, the Netherlands, and Denmark. Thirteen studies were of low quality, two were moderate, and one was high-quality. Three studies focused solely on dietary interventions, twelve studies combined diet, physical activity, and lifestyle counseling, and one study applied repeated health checks with personalized feedback and lifestyle advice. Overall, 10 studies reported a significant reduction in T2D incidence exclusively among high-risk individuals following the interventions with HR: 0.4 (95% CI: 0.3–0.7) to 0.75 (95% CI: 0.58–0.96). Only a few studies reported that primary lifestyle interventions decreased T2D risk, thus limiting generalizability. While lifestyle improvements were noted on high-risk groups, significant risk reduction among healthy individuals was not observed. Multicomponent interventions combining dietary modifications, physical activity, and personalized lifestyle counseling were the most effective in reducing the incidence of T2D among high-risk populations in the EU-28.

Background/Objectives: Type 2 diabetes mellitus (T2DM) represents a growing public health burden in the European Union (EU), largely driven by modifiable lifestyle factors such as diet. This systematic review aimed to synthesize observational evidence on the associations between nutritional exposures and incident T2DM across the EU-28, with a focus on regional heterogeneity and implications for EU-level nutrition policy. Methods: The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42020219994). Searches were conducted in different databases (PubMed, Embase, Scopus, Web of Science) identifying 23,437 records, from which 104 observational studies were included. Eligible studies involved adults (≥18 years) without T2DM at baseline and assessed dietary exposures in relation to T2DM incidence. Data extraction and methodological quality assessment were performed in duplicate using the NHLBI tool in Covidence. Results: Most included studies were cohort studies (77.9%), primarily conducted in Western, Northern, and Southern Europe. Diets characterized by high consumption of whole and minimally processed foods, such as fruits, vegetables, legumes, whole grains, and fermented dairy, consistently showed associations with lower T2DM risk. In contrast, high intake of red and processed meats, sugar-sweetened beverages, and ultra-processed foods was linked to higher risk. Adherence to Mediterranean or plant-based dietary patterns was associated with lower risk, whereas high animal-protein dietary patterns were detrimental. Conclusions: Nutritional determinants play a decisive role in shaping T2DM risk in the EU. Evidence supports prioritizing dietary patterns rich in plant-based and minimally processed foods while reducing ultra-processed and meat-based products. Tailored region-specific policies are needed to address the T2DM epidemic and guide effective prevention strategies.

Background: Physical inactivity affects 36.2% of adults in the European Union (EU), contributing substantially to the burden of non-communicable diseases (NCDs). The WHO’s Global Action Plan on Physical Activity 2018–2030 targets a 15% relative reduction in physical inactivity by 2030, supporting Sustainable Development Goal (SDG) 3.4.1 to achieve over 30% reduction in premature NCD mortality. This study estimates the number of averted deaths, premature deaths and cause-specific NCD deaths averted if physical activity targets are achieved across EU countries. Methods: We applied the WHO Preventable Risk Integrated ModEl using baseline physical activity and body mass index from waves 2 and 3 of the European Health Interview Survey. The counterfactual scenario modelled a 15% increase in metabolic equivalent of task hours/week of moderate-to-vigorous physical activity and a 15% relative reduction in the proportion of adults who are physically inactive across the EU. Findings: Increased physical activity is associated with an estimated 24 178 premature deaths averted by 2030 (95% uncertainty interval (UI): 23 253–25 103), equivalent to 3.3% of premature NCD mortality. Overall, 107 108 deaths (95% UI: 102 479–111 737) across all ages could be prevented, representing 4.7% of total NCD deaths in EU member states. Interpretation: Increasing physical activity alone is unlikely to achieve the SDG 3.4.1 target of reducing premature NCD deaths by 2030. However, when combined with other WHO ‘best buy’ interventions, such as improved diet and reduced tobacco and alcohol use, this target could be attainable across the EU.

We have less than ten years to achieve the 2030 Sustainable Development Goals (SDGs). In the health sector, it is crucial to focus on Goal 3, which aims for the health and well-being of everyone. Despite progress, disparities in healthcare access continue to affect vulnerable populations. Some countries have implemented Universal Health Coverage (UHC) to ensure equal healthcare access. This editorial emphasized the need for targeted interventions, policy reforms, and increased public awareness to achieve equitable healthcare access and better health outcomes for diverse populations. Keywords: disparities, policy reforms, SDGs, UHC

The Indonesian Journal of Health Administration Volume 11 No.1 (2023) has been published. This edition covers a wide range of main topics, including enhancing healthcare management, expediting Covid-19 vaccination efforts, and improving public health programs within the community. Healthcare sustainability is expected to help accomplish the Sustainable Development Goals (SDG) by 2030. Gupta et al. discuss environmental sustainability in healthcare using elicitation techniques and found that the hospital in India tends to utilize natural resource optimally to minimize the usage of electricity and water, install a waste treatment plant, and be accredited by a quality assurance body to assure them prioritize the sustainability in healthcare services. Regarding healthcare service equity, Suar analyzed the implementation of social inclusion in military hospitals in Indonesia. This study revealed that patients from particular groups received exclusive care compared to other National Health Insurance or Jaminan Kesehatan Nasional (JKN) program members. However, it contrasts with the Indonesian government's commitment to offer its citizens equitable and inclusive healthcare.