Prevention and screening

American Indians lived healthy, balanced lifestyles for thousands of years before they were displaced to reservations. Reservation lands were typically not suitable for sustaining their traditional healthy lifestyles, which involved hunting, gathering, fishing and farming. Many diseases including diabetes were unknown until the 1950s. Nowadays, however, diabetes and its complications are major contributors to death and disability in every Tribal community.

Every 30 seconds, a lower limb is amputated as a result of diabetes; of all the amputations in the world, about 70% are suffered by people with diabetes – foot ulceration being a key factor in developing regions. Yet these amputations can be prevented. As well as medical factors, numerous social and socio-environmental issues affect the development of diabetic foot problems. This report focuses on Africa-specific factors. Although in Africa neuropathy is a major contributing factor, it is not the only one: even a simple injury that becomes infected can be a precursor to amputation.

Globally, where the test is available, the measurement of haemoglobin A1c (HbA1c) has become central to the management of diabetes. By giving an objective assessment of glucose control over the preceding 2 to 3 months, it can guide treatment decisions in a way that single blood glucose measurements cannot. The authors describe efforts to standardize and improve the way HbA1c is reported, and explain the practical implications of the recent changes in the way the test is measured.

In 2005, the Government of Canada provided a renewed investment of 190 million CAD over five years to maintain and enhance the Aboriginal Diabetes Initiative. The main goal of the Initiative is to reduce type 2 diabetes and its complications through a range of culturally relevant health promotion and prevention services, delivered by trained health service providers and diabetes workers. Supported by Aboriginal Diabetes Initiative funding, Aboriginal communities across Canada are working to prevent and  manage type 2 diabetes. Amy Bell reports.

The potential threat from type 2 diabetes in  South Africa remains dangerously underestimated and its current prevalence widely unrecognized. Yet the problem is growing at an alarming rate. A series of factors that are particular to the region represent enormous obstacles to an effective response by people with the condition, healthcare providers and wider society. In this article, Noy Pullen identifies some of the key socio-economic, environmental and educational issues affecting rural South Africa.

Obesity, currently a worldwide epidemic, is associated with a number of conditions, including coronary artery disease, lipid abnormalities, gallstones, cancer and type 2  diabetes, obstructive sleep apnoea, and obesity hypoventilation. Recently, studies have shown that asthma may also be associated with, and perhaps worsened by, obesity. Ongoing research suggests that type 2 diabetes and asthma may be linked to obesity through chronic systemic inflammation.

The World Diabetes Day campaign is led by the International Diabetes Federation and its member associations. Created by the Federation and the World Health Organization in 1991, World Diabetes Day is an official United Nations Day. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight. The campaign is represented by a blue circle logo that was adopted after the passage of the United Nations Resolution on diabetes.

The standards for diabetes prevention vary greatly between the EU Member States. By sharing best practices and raising standards in the prevention of type 2 diabetes throughout the EU, the development of the condition in those at risk can be reduced. Major studies have demonstrated that prevention programmes can significantly reduce the risk of developing type 2 diabetes. Based on convincing evidence from clinical studies, the World Health Organization (WHO) and the International Diabetes Federation (IDF) have published recommendations for the prevention of the condition.

President's editorial

Like many other developing countries, Algeria is undergoing a transition in its disease  profile. The emergence of non-communicable diseases, including obesity-driven type 2