Phoenix rising: a better future for diabetes care?

Diabetes is, depressingly, coming of age – as has been forewarned incessantly in these pages over the past decade by a succession of IDF presidents, editors and expert authors. The paradox of the modern world offsets the potential benefits of globalization and rising prosperity (for some) with the personal and economic costs of the rising tide of diabetes and other costly chronic diseases – adding to the constellation of other serious socioeconomic and health challenges facing the world. Geography, poverty, social re-structuring, under-developed infrastructure and disruption by war and civil unrest threaten the lives of people with type 1 diabetes and feed the rising number of people with type 2 diabetes.

Growing wealth in some sections of society bring about lifestyle change by revolution, not evolution, driving the diabetes pandemic by mechanisms that remain unsuspected until after the event – and with unexpected side effects. In this issue, we learn that the obesity pandemic now may be a threat to the very processes that created it in the first place (like those obscure biochemistry formulae that describe reactions that can go in either direction in textbooks with two arrows pointing in opposite ways) through a little-discussed impact on climate change (page 25). But initiatives are underway that offer reason for optimism.

Santé Diabète was created in Mali some 20 years ago as the first development-related NGO to focus on protecting people with diabetes. It was a tiny outfit operating in a country facing multiple social and economic difficulties, including an epidemic of HIV/AIDS. Two decades later, with about half the population subsisting on USD 1.25 per day and multiple societal challenges – including political unrest and recent military activity in some regions – further complicating life in Mali, the activities of Sante Diabete have become crucial to the survival of people with diabetes. The group’s founder provides us with an update on the situation in Mali and brings a message of hope.

Another report from one of our Member Associations describes the challenges facing people with diabetes and their healthcare providers in Malawi, the ‘Warm Heart of Africa’. Malawi too is drinking from the poisoned chalice of development. As its economy improves (Malawi has become a net exporter of food), more and more Malawians living in rural areas are drawn to the many opportunities – for employment, health and social care – offered by life in the cities. As we have seen elsewhere, that rapid urbanization brings with it a sharp increase in risk factors for type 2 diabetes. Public awareness of the risks from diabetes to individual health has grown exponentially over the past decade – partly because there appears to be no one left these days who either does not have diabetes or does not know someone with the disease!

When any country is affected by extreme circumstances and multiple health challenges, people with diabetes tend to find themselves at the end of a dangerously long queue for aid and life-sustaining medication. Although insulin is classified by the World Health Organization as an essential medicine, people with diabetes in Port au Prince faced agonizing periods without insulin in the aftermath of the earthquakes that struck Haiti in 2010. We have recorded in earlier issues how civil society in Haiti, in the form of another small but highly motivated diabetes NGO, the Haitian Foundation for Diabetes and Cardiovascular Diseases (FHADIMAC), strove to plug those gaps in care provision. An update from Haiti in this issue reports on the situation in Haiti two years on. FHADIMAC has become a reference of the government’s plans to tackle diabetes. From the ashes of failing healthcare systems, new and sustainable structures might arise to improve previous provisions of care for diabetes and beyond.

New initiatives look not just at treatment for existing diabetes but also at its prevention. Noel Barengo’s article describes the development of a network for diabetes prevention under construction in Latin America; IDF’s BRIDGES projects develop and test deceptively simple interventions in both treatment and prevention.

Meanwhile, Diabetes Voice is pleased to include a contribution from an English celebrity chef, Jamie Oliver, who has given prominence to the axiom that if you want to change a society you start with the children. Mr Oliver makes clear that in terms of healthy food and how to prepare it, the developed world has much to learn from the developing world – those biochemistry arrows again! They can and should go in both directions and one of the political imperatives must be the recognition that the developed world does not have all the answers. The Phoenix has her work cut out, but we at IDF are there to give her a flying start!