Empowerment and self-management

Diabetes is mostly managed by people with the condition. In order to do so effectively, people with diabetes need to acquire and develop a broad base of knowledge and skills, and incorporate lifestyle choices into daily living which facilitate and enhance self-care. Diabetes education is an active process that supports people in building self-management skills, and provides for shared decision making about how best to fit diabetes treatment into daily life.

While both type 1 diabetes and type 2 diabetes can occur in children and adolescents, the overwhelming majority of people affected by diabetes worldwide are adults. Consequently, the specific needs of children are often overlooked. Type 1 diabetes, the most common chronic disease in children in developed countries, is growing by 5% among pre-school children and by 3% in children and adolescents each year – 70 000 new cases every year in children aged 14 years and younger worldwide.

Diabetes is increasingly common worldwide, and Kenya is no exception. The Ministry of Health estimates the prevalence of diabetes to be around 10% (3.5 million people). The cause of much human suffering, diabetes also places a considerable economic burden on individuals and families, and healthcare systems.

The rise in the number of people with diabetes in Morocco reflects current global trends. In step with the sharp and ongoing increase in levels of obesity in the urban populations, the prevalence of diabetes is rising. But while the threat of a full-blown diabetes epidemic in Morocco is growing, many people with the condition receive inadequate care as a result of shortages in human and medical resources, poor clinical facilities, and a lack of diabetes education.

Nobody can single-handedly manage the many and diverse aspects of diabetes. To be effective, diabetes care requires the coordinated input of people with diabetes and a range of healthcare providers, including a diabetes nurse, dietician, psychologist, pharmacist, physiotherapist or podiatrist, among others. Close

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.

Recent studies have highlighted the importance of good blood glucose control in people with type 2 diabetes and emphasized the importance of reducing cardiovascular risk, particularly in relation to the control of blood pressure. However, achieving this represents a real challenge for people who live with diabetes and those who deliver diabetes care. By way of a response to the need for improved diabetes care, the authors describe plans to initiate a peer-care model in Ireland.

Compared to people without the condition, people with diabetes are at increased risk from vascular diseases – including heart attack and stroke. This risk is further increased in people with diabetes who smoke; smokers with the condition should be advised by their health carers to stop smoking as a matter of urgency. But giving up the habit is not easy. Successful cessation requires people to surmount a number of difficulties, including strong physical, psychological and behavioural

If current trends continue, within the next 10 years, a quarter of all people in Mexico will be living with diabetes. Diabetes already affects 12% of the general population and, astonishingly, one in three people over 65 years of age. Diabetes is the leading cause of blindness, kidney failure and lower-limb amputations. Indeed, in 2004, diabetes was declared the leading cause of death in Mexico due to its link

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.