National diabetes programmes

The drastic rise in childhood obesity worldwide reflects the impact of unhealthy modern lifestyles. Over the last decade and a half, the increase of high-sugar, high-fat processed foods in our diets has combined with sedentary behaviour to radically and negatively affect the health of our societies. Initiatives are urgently required which can reduce the resulting individual and societal burden to physical and psychological health and economic development.

One day in 1997, when he and his family should have been celebrating his wife’s birthday, Guy Barnett’s life changed abruptly: having been diagnosed with type 1

The world is facing a dramatic rise in diabetes prevalence, most of which is occurring in the low- and middle-income countries; it is projected that by 2025, more than 75% of people with diabetes will live in developing countries. This is having a major impact on the quality of life of hundreds of millions people and their families. Furthermore, the negative effects of the obesity-driven diabetes pandemic are being felt in the economy of those countries that are in most need of development.

Diabetes has become a major health problem in developing countries, where non-communicable conditions are rapidly overtaking communicable diseases as the most common cause of death. Recent World Health Organization (WHO)

The urgent need to tackle obesity and prevent type 2 diabetes is now widely acknowledged, particularly by the health ministers worldwide who in May 2004 gave their unanimous approval to the World Health Organization (WHO) Global Strategy on Diet, Physical Activity and Health. Many health ministries around the world have policies to cope with these most pressing public health issues. But their detailed strategies are often unclear. Indeed, almost everywhere, national programmes to address obesity and diabetes are still under development.

Cuba is a small island country in the Caribbean with 11 million inhabitants. As in other countries, diabetes is a major challenge to health in Cuba. In order to reduce the health and economic impact of diabetes and improve the quality of life of people with the condition, a country-wide diabetes education programme began development over 30 years ago, linking and promoting optimum care and education. Rosario García and Rolando Suárez report on the achievements of the programme and highlight the central role of diabetes education over three decades of care initiatives in Cuba.

Over the last 10-15 years, various regional institutions in the Caribbean have developed protocols for the clinical management of diabetes. These have been used to improve the quality of care for people with the condition. However, the nutritional component of care was not adequately addressed in these recommendations and no standardized regional guidelines existed. Godfrey Xuereb reports on the development of a formal protocol for the nutritional management of diabetes and related conditions in the Caribbean region.

Bolivia is a land-locked country in central South America. Bordered by five nations, it is one of the so-called developing countries; levels of infant mortality and illiteracy are among the highest in the world. While Bolivia is rich in ethnic and cultural diversity and natural resources, including silver and natural gas, the development of the nation continues to be constrained by economic and societal problems which affect all levels of society. Furthermore, the areas of health and education have

In his Nobel Prize lecture, the writer VS Naipaul described from the point of view of a boy of Indian origin born in Trinidad in the 1930’s the ethnic and cultural diversity of this small southern Caribbean island state. In this culturally rich but challenging setting, with few available resources, diabetes educators have made significant advances in facilitating diabetes education in Trinidad and Tobago and in raising awareness of the condition countrywide. Zobida Ragbirsingh reports.

On the occasion of the signing of the St Vincent Declaration in St Vincent, Italy in October 1989, representatives of diabetes organizations and government health departments from European countries agreed unanimously on key health objectives for people with diabetes. Five-year targets were incorporated within the framework of the Declaration, which effectively recognized that diabetes outcomes were measurable; European nations were thus challenged to improve standards of care.