Psychological issues

Nigeria, with a population of about 128 million people, is Africa’s most populous country. Life expectancy at birth is 47 years; about 60% of the population live below the poverty line. While healthcare structures and institutions are inadequate, and there is a chronic lack of skilled healthcare personnel, diabetes is on the increase. Uncontrolled urbanization is the driving force behind rising obesity levels and a subsequent boom in levels of type 2 diabetes.

The 10-year National Diabetes Programme in Finland (DEHKO) has been up and running for 6 years. The formal evaluations carried out to date indicate that the Programme continues to have a positive impact in a number of areas of diabetes care in Finland. Moreover, prevention of type 2 diabetes and cardiovascular complications remain the principle objectives of DEHKO. Timo Saaristo and Leena Etu-Seppälä report on FIN-D2D (2003-2007), the DEHKO project to implement primary prevention of type 2 diabetes in five regions – potentially affecting 1.5 million people.

It is estimated that about half of all homeless people suffer from chronic medical conditions. Unfortunately, these people frequently encounter many more barriers to care than the general population – exacerbating their health problems. The plight of homeless people with diabetes is particularly severe, since managing the condition requires adherence to a demanding care plan.

The Diabetes Attitudes Wishes and Needs (DAWN) programme was launched in 2001 with the global DAWN study. Initiated by Novo Nordisk in partnership with the International Diabetes Federation (IDF) and an international expert advisory board, the DAWN programme aims to respond to shortcomings in diabetes care; less than half of the people who are diagnosed with diabetes worldwide reach optimal health and quality of life. The 3rd DAWN summit, which was held recently in Florence, Italy, gathered 900 experts, people with diabetes, policy-makers

Diabetes is affecting more and more people every year. In the last decade, the number of people diagnosed with diabetes of one kind or another increased by almost 50%. By the year 2025, more than 300 million people around the world could have been diagnosed with the condition. Many others who have diabetes will not have been diagnosed. Diabetes also represents a major threat to the health of the world’s millions of migrants, who appear to be at greater risk of developing diabetes than non-migrants. Manuel Carballo and Frederik Siem report.

The results of the Diabetes Attitudes, Wishes and Needs (DAWN) study confirmed the beliefs of many people with diabetes and health-care providers: that addressing only the physical symptoms of diabetes is not enough; to be truly effective, diabetes care must also take into account psychological issues. Nowhere was this more apparent than in Poland, where people with diabetes showed consistently higher concern for psycho-social issues than respondents in other countries. Andrzej Kokoszka reports from Poland on an award-winning educational initiative in response to these needs.

Over half of all lower-extremity amputations are related to diabetes. Indeed, foot ulceration is an increasing problem worldwide and there is little evidence of a reduction in the numbers of foot ulcers and amputations in people with diabetes.

In 2000, a group of committed members of the diabetes community in Egypt, including parents of children with the condition and health-care professionals, established ‘Assistance to Youngsters with Diabetes’ (AYD). This is an ambitious project. The ultimate objective of AYD – which recently won the DAWN International Award – is to enhance the quality of life of children with diabetes in

The number of people with diabetes in the Indian subcontinent has been increasing dramatically: approximately 30-33 million people have diabetes in India and this number could double by 2025. Compared to other ethnic groups, Indians have a high risk of developing diabetes. However, the impact of psycho-social factors related to diabetes care has also contributed to the growing pandemic.

The Internet has become a useful tool that is relatively easy to operate. With little effort, huge amounts of information can be found about specific health conditions or health in general. Views and concerns about health can be shared with literally millions of other people; spreading health information to people around the world is a simple process. Clearly however, there is a need to evaluate this information