This adds to a 2011 UN initiative to stem the rise in prevalence of diabetes by 2025, as well as to reduce premature deaths from non-communicable diseases, part of Sustainable Development Goal 3. In today's Lancet, the NCD Risk-Factor Collaboration (NCD-RisC) report that in 2014, an estimated 422 million people worldwide were living with diabetes—roughly a four-fold increase over the past 35 years. The NCD-RisC pooled data from 751 studies that measured either fasting plasma glucose or haemoglobin A1c to determine global and regional trends in diabetes prevalence. And, as Etienne Krug highlights in an accompanying Comment, these data “sound the alarm for large-scale, effective action”.
The outlook for some regions is promising, with almost no changes in age-adjusted prevalence reported for both men and women in north-western and south-western Europe from 1980 to 2014, remaining below 6% for women and 8% for men. By contrast, in 2014, prevalence was higher than 25% in some islands of Polynesia and Micronesia, and as high as 31% and 33% for men and women, respectively, in American Samoa, which are also regions with high rates of obesity. These divergent statistics clearly show that beating diabetes on a global scale cannot be achieved with a one-size-fits-all approach.
Coinciding with World Health Day this year, WHO released its first ever Global report on diabetes. It reveals that in 2012, a total of 3·7 million deaths were attributable to higher-than-optimal blood glucose levels. The report calls for multi-sectoral, population-based approaches to help reduce risk factors for diabetes in the general population, and recommends a life-course perspective that instils healthy eating and physical activity from an early age to prevent type 2 diabetes later in life. Importantly, regulation of marketing, trade, and agricultural policies to promote healthier eating is also proposed.
The tide toward prevention is beginning to turn, albeit slowly. Last month, the UK Government announced the roll-out of Healthier You: The NHS Diabetes Prevention Programme, which offers personalised lifestyle and behavioural modification advice to individuals at risk of developing type 2 diabetes. In 2016, 20 000 referrals will be offered across 27 regions, with nationwide coverage and 100 000 annual referrals expected by 2020. According to the US Department of Health and Human Services, a pilot diabetes prevention programme tested in nearly 8000 people has shown that lifestyle counselling that encourages healthy eating and exercise improvements can lead to weight loss and diabetes prevention. Encouragingly, this is the first programme in the USA to prove an economic case for diabetes prevention, with estimated savings of US$2650 per enrollee over a 15-month period. On this basis, the Obama Administration has proposed that the Diabetes Prevention Program be incorporated into Medicare for beneficiaries with pre-diabetes, as early as 2017.
Prevention is of utmost importance, but for the more than 420 million people currently living with diabetes, managing their disease must remain the priority. WHO's report recommends a multidisciplinary approach with patient education, medication, and consistent follow-up.
Furthermore, engaging patients in structured education programmes, such as DAFNE, for individuals with type 1 diabetes, improves life expectancy, diabetes-related complications, and hypoglycaemic awareness, and reduces the financial burden of disease management. Given that 80–90% of cases are type 2 diabetes, which is linked to obesity and lifestyle, structured self-management programmes that can be delivered to large numbers of patients are urgently needed.
We welcome such programmes, but more intensive efforts are needed. To this end, The Lancet and the Chinese University of Hong Kong announce a new Clinical Commission, led by Juliana Chan and Edward Gregg. The Commission will review available scientific evidence, analyse and evaluate existing policies to address diabetes, and devise a strategy and accountability framework for short, medium, and long-term solutions to address the growing unmet needs in diabetes prevention and control.
The massive increase in prevalence of diabetes, in particular type 2, is sobering. The NCD-RisC group estimates that if prevalence continues to rise at the rate of the past 15 years, the probability of halting global diabetes prevalence at 2010 levels by 2025 is less than 1%. Worldwide, the number of adults with diabetes will surpass 700 million. World Health Day 2016 is a prime opportunity for patients, the community, health-care providers, and policy makers to refocus efforts to end the diabetes epidemic. Immediate action is needed to avert this escalating health disaster.
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