Health Delivery


The IDF definition: why we need a global consensus

There is a constellation of metabolic abnormalities which includes centrally distributed obesity, decreased levels of HDL cholesterol, elevated triglycerides, high blood pressure, and high blood glucose (hyperglycaemia). This is known as the metabolic syndrome. Associated with a five-fold risk for type 2 diabetes and two- to three-fold increase in risk for cardiovascular disease, the metabolic syndrome is now considered one of the principal public health issues of the

Managing the diabetic foot: treatment, wound care and offloading techniques

Foot ulcers are caused by an imbalance between excessive pressure on the sole of the foot and repetitive stress from walking. It does not take much pressure to provoke an ulcer, so the skin has a built-in protection system. Normally, harmful pressure or motion against the skin will set off a protective pain alarm. Unfortunately, in people with diabetes nerve damage (neuropathy), this pressure goes undetected and can cause serious injury. Having lost the ‘gift of pain’, people with diabetes neuropathy often do not notice the problem until an ulcer has formed.

Multidisciplinary care: saving Mr L's toe

This is the story of ‘Mr L’, a man in Australia with type 2 diabetes and severe diabetes nerve damage (peripheral neuropathy). He developed neuropathy-related ulcers on one of his toes, which remained untreated for a number of months. He faced the prospect of having his left foot amputated. However, this was prevented because Mr L was linked to a multidisciplinary hospital-based diabetic foot clinic.

Glucose control: closing the gap between guidelines and practice

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.

The role of the renal dietitian in diabetes care

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.

Building Blocks in diabetes care and prevention in Paraguay

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

Can a peer-care model improve diabetes outcomes?

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.

Meeting psycho-social needs in Poland: a new priority

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.

Diabetes care and prevention in Iran

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.

Large-scale diabetes awareness and prevention in South India

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)