Breaking down barriers

Sir Michael Hirst

Successful management of diabetes is a reflection of community.

People living with type 1 or type 2 diabetes successfully may consider their ‘diabetes family’ to be a diverse set of individuals who are informed about their condition and care for them. The list is as long as it is varied: a spouse or partner; children and siblings; local doctors and nurses; social workers and pharmacists; teachers and classmates; friends and neighbours; colleagues and clients: and all the other individuals who make a difference in the lives of people with diabetes.

DAWN2TM, a global initiative to assess the advancement of person-centred diabetes care, reasonably validates the disastrous effects of a high burden condition in communities where awareness and support are low, discrimination is high and care is suboptimal. The result? People with diabetes in these communities live in a world dominated by silent fear and denial until blindness or other major complications strike. The tipping point for the dramatic increase in the number of people who live with diabetes in the 21st century has already arrived, and diabetes associated mortality rates will continue to increase if affordable and equitable access to care, treatment and self-management education, regardless of race, ethnicity, gender and age, including access to psychosocial care and support, are not provided. One of the most significant barriers to progress is discrimination. The effect of discrimination felt by people living with diabetes and acknowledged by caregivers and families is real. Discrimination influences quality of life and clinical outcomes. The time to break down barriers of ignorance is now.

Given that type 1 and type 2 diabetes are managed primarily in the home and workplace outside of a healthcare facility, it’s no surprise that families of people living with diabetes are impacted by a shared burden and distress. Notably DAWN2 broadened the scope of the original study to include family members, in addition to people with diabetes and healthcare professionals, and the findings require our attention. Nearly half of all people who live with diabetes in the world have high emotional distress related to their condition, and over one-third of family members of people with diabetes report a significant shared burden and feelings of helplessness. Improvements are desperately needed for patient care, education, psychosocial and community support but broadening the scale of resources to family members is an obvious factor.

In an effort to help people embrace the principles of effective self-management strategies, and empower them with information and confidence, IDF International Charter of Rights and Responsibilities of People with Diabetes stands up for people living with diabetes but also acknowledges the condition of acceptance. The stigma and discrimination so harshly associated with diabetes are eradicated when the power of information, awareness and acceptance blend into one. The global challenge of diabetes requires a commitment to long-term solutions and immediate interventions in a variety of settings and cultures, but incongruous layers and a multitude of factors make change hard to achieve at the human level. We cannot allow this to become a deterrent. It is our task to translate research and study into actionable steps that will challenge the diabetes epidemic, especially in low and middle-income countries and where urbanization is changing the fabric of daily life for millions of people.

However, it would be an over-simplification to say that diabetes can be controlled and largely prevented if people living with the condition, their families and medical professionals would just take responsibility. The burden of diabetes challenges a wide range of public health, economic and medical science issues socially and geographically, and will continue to impact future generations if we don’t curb the epidemic. We must secure government commitments otherwise the consequences of diabetes will continue to cause death, disability and suffering. It is our task to push progress for action on diabetes prevention, treatment, rights and political leadership in line with the UN Political Declaration on Non-communicable Diseases signed in 2011 and Global Targets adopted in 2013. IDF Global Diabetes Scorecard will assist in tracking efforts and outcomes, but we must continue to drive obligation and duty versus voluntary government action. If IDF is going to help halt the rise in diabetes today, then we are obliged to pressure global and local health agendas now. The hype must be translated into real commitment and result in achievement. It is our sole mission.

For only the second time in the 60-year history of our organisation, IDF is bringing the leaders of diabetes today together in the Western Pacific Region, where a third of the world’s population with diabetes live, over 132 million. Unsurprisingly, Melbourne has experienced the highest number of abstracts submitted for a World Diabetes Congress, in part do to the hard work of, Paul Zimmet, Chair of the Scientific Programme Committee together with the talented leads. I must also mention past IDF President Martin Silink, who with long lasting effect led the campaign for the UN Resolution on Diabetes in 2006. It is an honour to pay tribute to all our colleagues in Australia, especially to those who have worked with flair and diligence to achieve such an impressive and influential 2013 World Diabetes Congress. I hope you’ll join me in thanking them for their great hospitality.

Editorial, type 1, type 2, diabetes, DAWN2 study