Health Delivery

While fewer people with Type 1 diabetes are developing end-stage kidney disease (end-stage diabetic nephropathy, ESDN), the number of people with Type 2 diabetes reaching ESDN is growing rapidly. In this article, Eberhard Ritz answers some key questions about the issues around care for people with diabetes who suffer ESDN.

Research advances in diabetes have led to increased therapeutic options for people with the condition. This has led to increasing levels of satisfaction among the consumers of these treatment options – people with diabetes. One aspect of satisfaction deals specifically with the person's evaluation of medical treatments. Treatment satisfaction

Populations around the world are getting fatter. People of all ages are showing signs of diabetes and other conditions which are associated with being fat. It has been found that people of African, Asian and Hispanic origins are at particularly increased risk from obesity and obesity-related conditions such as diabetes. Due to a variety of cultural and socio-economic factors, women from these populations seem to be at especially high risk from the dangers of overweight.

The people of the Caribbean region are facing a serious threat to health which will potentially overwhelm healthcare systems in the small and relatively poor countries of the region. It is estimated that by the year 2010, the number of people with diabetes in the Caribbean will reach 20 million. Diabetes prevalence in the area is projected to increase to approximately 25% of the adult population.

In this article, Alistair Emslie-Smith reports on the considerable improvements to diabetes care which are offered by the Diabetes Audit and Research in Tayside Scotland (DARTS) system. This initiative serves as a register and database for all diabetes care activity across the region. DARTS offers a wide range of resources for people with diabetes, health professionals, and those with an interest in the condition.

Ethiopia is a mountainous and beautiful country. The capital city, Addis Abba, is about 2500 m (8000 ft) above sea level. Around 85% of the people are farmers who live in circular thatched huts called tukuls. These are grouped into small villages which are often remote and inaccessible. While unpaved roads link the main centres, many areas can be reached only by footpaths. Road transport is either by bus or taxi, both relatively expensive; or by mule or on foot, which are laborious and slow.

As the number of people with diabetes increases worldwide, there will be an increasing need for diabetes education. New approaches are necessary to ensure the cost-effective provision of this education for each person with diabetes. Diabetes education will be offered by both health-care professionals and non-professionals. New programmes will be developed and non-medical educators will receive training in order to deliver diabetes education.

Diabetes is classified into two major types: Type 1 (insulin-dependent) diabetes, and Type 2 diabetes. However, it is apparent that there are some forms of the condition which do not fit comfortably into these categories. Indeed, there is one form of diabetes which appears to straddle the two major types. While it appears to affect adults with Type 2 diabetes, it shows many of the genetic, immune, and metabolic features of Type 1 diabetes, and carries a high risk of progression to insulin dependency. This form of the condition is known as 'latent autoimmune diabetes in adults' (LADA).

Type 2 diabetes has reached pandemic levels, with the global number of people with the condition predicted to exceed 330 million by 2025. Overall, at least 50% of those with diabetes presently do not know that they have the condition. In developing countries the proportion with undiagnosed diabetes is considerably higher. At the time of clinical diagnosis, every second person with diabetes has already developed one or more micro- or macrovascular complications.