Education

As in many countries of the world, Syria, with its 16 million inhabitants, has witnessed a tremendous change in food habits and lifestyle within the last few decades. This has been reflected in the rise of metabolic diseases in general and diabetes in particular. Three studies have shown that the prevalence of diabetes in Syria is probably higher than published reports have claimed. One of the aims of the Syrian National Diabetes Programme, adopted in 1995, was to assess the national situation by carrying out epidemiological studies.

The first systematic epidemiological studies in Iran were begun in 1993. However, in light of the growing number of people with diabetes and the accruing costs, estimated to exceed US$400 million a year, a need was recognized in 1998 to study the more recent epidemiology of diabetes in Iran. In 1998 the National Committee for Diabetes was formed, and a project undertaken in 1999 involving nearly 2.5 million people. Many other substantial moves have been made in Iran to help deal with diabetes in the country.

The ‘Fundación Diabetes Juvenil de Chile’, the Chilean Juvenile Diabetes Foundation, a non-profit institution, was founded in 1988 by a group of parents of children with diabetes. The principal objective of the institution is to help all people using insulin by teaching modern techniques, observing treatment and promoting self-monitoring. The Foundation provides additional support to the medical team responsible for treating people with diabetes. This generally refers to the area of education.

The prevalence of diabetes in Latin America will double within the next couple of decades. Type 2 diabetes is already among the first 10 causes of mortality in the Latin American adult population due to chronic complications related to premature and accelerated atherosclerosis. It is also estimated that around one third of these women and half of these men remain undiagnosed for years. Latin America must, therefore, be prepared for an epidemic with serious consequences.

Diabetes is on the increase in Indonesia, with prevalence rates now at 4.6% compared with 2% to 3% just five years ago. This means that some four million people throughout Indonesia, from Sumatra to Irian Jaya, currently have the condition. Bali, an Indonesian island with three million inhabitants, has trained 86 diabetes educators since 1996. The educators, who come from all over the island, are expected to be able to return to their local areas and spread their knowledge about diabetes.

Diabetes is one of the most common long-term progressive diseases of childhood. In many parts of the world Type 1 diabetes in children is increasing by 3% to 5% each year. Type 2 diabetes is also declaring itself in younger and younger age groups. These children have a lifetime of diabetes ahead of them. In an effort to contribute to an improvement in the care and quality of life of young people with diabetes, the International Society for Pediatric and Adolescent Diabetes (ISPAD) recently published comprehensive consensus guidelines.

For most Ethiopian immigrants arriving in Israel, diabetes was an unknown illness. However, current studies show that its prevalence is now high in this population. The diagnosis and management of diabetes among Ethiopian immigrants present a real challenge of acculturation. In response to this challenge, a community-based project called Tene Briut was created. Tene Briut promotes culturally-appropriate prevention, detection and management activities, with a major contribution from Ethiopian health professionals and community leaders.

According to Diabetes Atlas 2000, there are 21.4 million people with diabetes living in the North American region of the International Diabetes Federation (IDF). Prevalence rates of diabetes are high in this region as compared to Europe and Africa. The Caribbean countries in particular have a disproportionately high number of inhabitants with diabetes. Indeed, several islands in the Caribbean rank in the top 10 of all IDF member countries in terms of diabetes prevalence. The need for diabetes education in the region is therefore high.

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).

Children need a healthy mother, not one with incapacitating complications, an unstable character due to the highs and lows of blood glucose levels, or who might endanger them by losing control while having a severe hypoglycaemic reaction. Children need a full-time caregiver. A responsible woman educated to take command of her diabetes can fulfil this role just as well as a woman without diabetes; sometimes even better.