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Addressing inequalities in access through long-term collaboration

Diabetes is a life-long chronic condition. Herein lies one of the major challenges to addressing global inequalities in diabetes care. The costs of insulin and monitoring are often beyond the resources of people with diabetes or their country’s healthcare system. While it is easier to secure temporary price reductions or short-term financial support in the form of donations or grants than it is to find long-term ongoing support, diabetes needs in most countries are not temporary.

Diabetes monitoring in developing countries

The latest statistics suggest that in the future the majority of people with diabetes will live in developing countries. There are an estimated 35 million people living with diabetes in India, for example, and it is estimated that this number will rise to more than 73 million by 2025. Sadly, it follows that the majority of people with diabetes complications will come from countries whose health systems are not able to deliver quality diabetes care.

Global access to and availability of insulin

The first practical use of insulin by Banting and Best in 1921 heralded a medical revolution. Overnight, type 1 diabetes went from being a uniformly fatal disease to a manageable disorder. Thousands of people around the world have received awards for surviving 50 years on insulin – some reaching 80 years. Insulin is classified by WHO as an essential drug. Yet, 85 years after its discovery, untold thousands of people with type 1 diabetes and type 2 diabetes in developing countries die each year because they can neither readily access nor afford insulin.

Education and public information: preventing diabetic ketoacidosis in Italy

Left untreated, diabetic ketoacidosis has a 100% death rate. Indeed, ketoacidosis is a leading cause of death and disability in children with type 1 diabetes. Severe acidosis often develops during an extended period in which hyperglycaemia-related symptoms are misdiagnosed. Reducing this period may be sufficient to prevent severe acidosis in newly diagnosed children with diabetes.

Nutrition and diabetes: global challenges for children and parents

Many children around the world are starving or undernourished. In contrast, obesity and type 2 diabetes in children are major problems in many countries. These contradicting nutritional crises strongly affect the way we care for children with diabetes and their families. Recent international guidelines on the care of children with type 1 diabetes and type 2 diabetes recognize that effective nutritional management and the adoption of a healthy lifestyle can improve diabetes outcomes.

What is so different about diabetes in children?

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.

Variations in risk perception: South Asians living in the UK and their healthcare professionals

Diabetes has become a global health problem, reaching epidemic proportions worldwide with serious implications for health and well-being. The International Diabetes Federation estimates that by 2025, almost 350 million people will have diabetes. People who are most vulnerable to this chronic disease include those living in developing countries, and members of minority ethnic groups and socio-economically disadvantaged people in developed countries.

Striving for comprehensive diabetes care in Uzbekistan

As the number of people with diabetes continues to rise worldwide, huge increases in the prevalence of the condition are expected in Asia. Hospital and outpatient care for people with diabetes in the central Asian Republic of Uzbekistan, with a population of over 26 million people, is provided at state-funded healthcare centres. However, people with the condition have to pay for their insulin and other essential diabetes supplies out of their family income. Diabetes-

National and regional organization: the key to effective diabetes care in Moscow

According to the federal statistics agency of the Russian Federation, the country’s population is in a phase of negative growth and currently stands at around 143 million. There are 2.3 million people registered with diabetes, 2 million of whom have type 2 diabetes. However, according to recent epidemiological research, there may be some 8 million people living with the condition in Russia. Success in addressing the problems relating to diabetes and its complications largely depends on the effective organization of diabetes care at regional and national levels.

Prevention of diabetes and its complications: key goals in Finland

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.

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