Diabetes Will Be A Bigger Burden Than Predicted, The Lancet

Main Category: Diabetes
Article Date: 02 Mar 2007 - 1:00 PDT

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WHO has predicted a 39% rise in the worldwide prevalence of diabetes between 2000 and 2030, but an Article in this week's Lancet indicates that this figure might be a gross underestimation.

Using populationbased data from Ontario, Lorraine Lipscombe and colleagues have observed a 69% increase in the prevalence of known diabetes from 1995 to 2005; an increase that already exceeds WHO's predicted rate.
The authors of this study acknowledge that the climbing rates of diabetes observed could be partly due to extensive immigration from regions with diabetessusceptible populations, such as south Asia. Ethnic origin is a well-known risk factor for the disease, with individuals of African and Caribbean, Latin American, and Asian descent all being particularly susceptible; and all those who develop diabetes are at increased risk of complications, including lower-extremity amputations and end-stage renal care. These at-risk populations require a tailored approach to prevention and management.

The increasing incidence observed in ethnic minorities and the young, coupled with decreasing mortality rates and extended life expectancy, means that prevention is the best method of reducing the global burden of diabetes.

Regular screening programmes must be available for those most at risk, to ensure early diagnosis and effective control.

Doctors need to be aware of cultural influences that affect specific high-risk populations, such as diet and lifestyle, and tailor their care appropriately, with an emphasis on self management in the community. In conjunction with this strategy, the education of susceptible ethnic groups - to inform about risk factors, preventive measures, and effective management - is also crucial. However, for these incentives to be effective, and to stem the rising prevalence of diabetes in these at-risk minorities successfully, equal standards of access to care for all patients must be achieved. A one-size-fits-all approach is not optimal for the treatment of a disease that affects subpopulations differently. Every country needs to devise a customised policy of care, dependent on the ethnic constitution of its population, for effective worldwide control of diabetes to be attained.

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