Patient-centred care

Relatively few studies have examined the psycho-social impact of diabetes. The Diabetes Attitudes, Wishes and Needs (DAWN) Programme addressed this issue in a study involving people with diabetes from 13 countries. A key finding was that depression was much more common in people with diabetes than in those without the condition, and was associated with impaired self-management and quality of life. Other studies confirm that depression often impairs metabolic control in people with the condition.

The establishment of a practice which puts the person at the centre of care will require a change in the attitudes and beliefs of health professionals, and people with diabetes. A service which places the person with diabetes at the centre of care will undoubtedly demand the adoption of this philosophy by the organizations responsible for the delivery of diabetes care, as well as those networks serving the

It is widely agreed that people with diabetes can lead a 'normal' life. Like people who do not have the condition, people with diabetes can function fully in family, workplace, and community settings. However, it is also accepted that diabetes self-care is complex and demanding. Being obliged to balance food intake and exercise against medication, self-administer injections, and self-test blood for glucose levels is not 'normal'. The demands of diabetes self-management can impact negatively on the psychological status of people with the condition. In this article, Ruth

In diabetes care, the principal objective is to improve health outcomes and ensure the total well-being of people with the condition. In order to achieve this, it is important to reach the person beyond the laboratory results and blood glucose

The overall objective of Diabetes Attitudes, Wishes and Needs (DAWN) is to improve the psycho-social support for people with diabetes. This global Programme is led by Novo Nordisk, in partnership with the International Diabetes Federation (IDF), and an advisory panel of leading diabetes experts. The DAWN activities began with the DAWN Study in 2001. This global investigation into the affective aspects of the condition facilitated comparisons and cross-referencing between the key players in the diabetes community. The key finding was that critical gaps

The findings of the recently-conducted DAWN study (Diabetes Attitudes, Wishes and Needs) tell us that people with diabetes who are cut off from a community of support not only manage their condition ineffectively, but also feel worse within themselves. Networks of supportive family, colleagues or friends appear to be at least as important as medication in relation to the ability of a person with diabetes to manage their condition.

In the 1950s and 1960s diabetes prevalence in Ghana was estimated at between 0.2% and 0.4% in adults. However, a recent analysis of admissions to the largest hospital in the country reveals that diabetes accounts for 6.8% of all adult admissions. Despite the fact that diabetes is clearly a major health problem in Ghana, the country has no separate diabetes healthcare policy. To address these issues, a three-year national programme, the Ghana Diabetes Programme, was initiated in 1995.

In England we are currently increasing public spending on health faster than any major country in Europe. But, along with investing more, we need to do things differently. We need to look more radically at how health services are provided within a network of health and social care, shifting the balance between what we do in hospitals and what we do elsewhere. These are the principles that we will apply to modernizing diabetes treatment and that will underpin the ongoing work of the National Service Frameworks (NSF).

The scale of the problem that diabetes poses to world health is still widely under-recognized. The International Diabetes Federation (IDF) estimates that if current trends continue, the number of people with diabetes will almost double; from 194 million people in 2003 to 333 million by the year 2025. Diabetes is already the most costly health-care problem in the westernized and 'westernizing' countries.

Editor-in-Chief's editorial