The Urgent Need: Prevention and Management

KEY MESSAGE

There is an urgent need for governments to face the challenge of translating the evidence on preventive initiatives into affordable and feasible programmes in order to curb the diabetes epidemic. At the same time, investments must be made in diabetes care and management, including diabetes education, to enable the millions of people with diabetes to lead full and productive lives.

A substantial proportion of type 2 diabetes is preventable, while the prevention of type 1 diabetes remains a critical area for research. This section looks at some of the evidence that confirms that there are effective measures to prevent or delay the onset of type 2 diabetes. Such measures include supporting changes in behaviour to reduce overweight and increase physical activity, and the use of certain glucose lowering drugs. This section raises the challenge of how to translate the evidence from well-resourced research studies into initiatives that are affordable and feasible, whether in richer or poorer parts of the world. It is clear that what is needed are not only initiatives to identify people at high risk of developing type 2 diabetes, for whom appropriate preventive measures can be provided, but also measures that will lower the risk across the entire population. Population-wide measures will need to include approaches to increasing physical activity and promoting healthier diets. Such measures require actions outside the health sector. For example, measures may include policy initiatives in areas such as transport, urban planning, food pricing, food advertising and education. In short, a sector-wide approach is needed.

The challenges of diabetes for the individual and society, with a particular emphasis on type 2 diabetes, are also examined. For those who have diabetes many of the complications can be prevented or delayed with access to the right support and healthcare. Good control of blood glucose, lipids and blood pressure, high quality foot care and retinal screening are examples of measures that are known to be effective. Even in low-resource settings there is much that can be done to improve the lives of people with diabetes.

Providing good diabetes care for a population requires coordination across three levels of organization. At the micro level, and at the centre of all care, are the people with diabetes, their families and their immediate carers. At the meso level is the community and healthcare organizations within which care is delivered. At the macro level are the supporting policy and financing frameworks. The World Health Organization’s Innovative Care for Chronic Conditions Framework provides guidance on the relationships between, and the contents of, these three levels. This framework can be used to help repair the fragmentation of health services across the range of needs that people with diabetes have, and to provide links to broader population interventions, such as those for the prevention of diabetes.

The person with diabetes is the key member of the diabetes management team, as on a day to day basis they make most decisions that affect their care. This section also looks at the urgent need to invest in diabetes education, the cornerstone of self-care management, in all healthcare systems. Investment must be made not only to ensure specialized diabetes education is accessible to healthcare personnel and people with diabetes but also to ensure both groups are trained in how to implement change.