Health Delivery

The Global Partnership for Effective Diabetes Management is a multidisciplinary task force of international diabetes experts. The group came together in 2004 with the objective of supporting improvements in treatment outcomes for people with type 2 diabetes. The aim of the Global Partnership was not to develop another set of guidelines, but to provide practical advice to help more people to achieve good glucose control.

Renal dietitians can be especially helpful to people who have diabetes and its kidney complications. However, in a recent survey by the US National Kidney Foundation Patient Services Committee, only two out of 25 respondents received help from a registered dietitian. Yet, when asked to list any queries that related to their diabetes care, two-thirds of these were related to nutrition. Patricia Weber describes the importance of nutritional issues in the prevention of diabetes-related kidney failure and calls for an increased role in diabetes care for renal dietitians.

An ongoing initiative of the Pan American Health Organization/World Health Organization focuses on the development of basic procedures to improve diabetes prevention and control: the Building Blocks project. A set of diabetes care guidelines based on the Building Blocks principles resulted from a number of regional workshops involving experts in a variety of diabetes-related fields

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.

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.

The world is facing a dramatic rise in diabetes prevalence, most of which is occurring in the low- and middle-income countries; it is projected that by 2025, more than 75% of people with diabetes will live in developing countries. This is having a major impact on the quality of life of hundreds of millions people and their families. Furthermore, the negative effects of the obesity-driven diabetes pandemic are being felt in the economy of those countries that are in most need of development.

Diabetes has become a major health problem in developing countries, where non-communicable conditions are rapidly overtaking communicable diseases as the most common cause of death. Recent World Health Organization (WHO)

Although diabetes-related amputations are preventable, for too many people around the world, losing a limb or part of a limb is a tragic consequence of having diabetes. The high rates of these amputations are an indication of inadequacies in the delivery of health care, which create enormous challenges for those attempting to access high quality foot education and care. In this article, Margaret McGill focuses on current recommendations for health-care providers and makes a call for an individualized approach to diabetes foot care.

Figures released by the International Diabetes Federation suggest that worldwide in 2003 there were almost 200 million people with diabetes – a global prevalence of 5.1%. The report predicted that over the coming decade, the greatest increases in the numbers of people with the condition will occur in Africa and Asia, provoking hugely increased rates of death and disability. Diabetes foot complications constitute a major public health problem, particularly for people with diabetes in developing countries. In this article, Zulfiqarali Abbas and Stephan Morbach look

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