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New report provides recommendations for global diabetes care

A new report provides several core recommendations for improving type 2 diabetes care on a global scale.
The document, which was conducted by researchers at the Icahn School of Medicine at Mount Sinai, New York, used information from 14 countries to make its recommendations.
Type 2 diabetes care: a global challenge
There are 382 million people worldwide with type 2 diabetes, and rates are increasing in the vast majority of countries. Some parts of the world are more heavily affected than others – the Americas, for example – and each region has its own way of approaching type 2 diabetes care. Mexico, for example, implemented a sugar tax to drive down consumption of sugary drinks, with great success.
However, type 2 diabetes cannot be solved with a single blanket global approach. There will no doubt be parts of the world where sugar taxation is unsuccessful. This is because each regio, and even each country, is faced with its own set of unique challenges that contribute to type 2 diabetes. These challenges can be environmental, political or economical. It is important that any set of global recommendations – like the ones presented in this study – take these specifics into account.
Despite this, information from one country can still be useful to another. That’s why this study collected data from a range of studies: in order to draw a “global picture” of diabetes, from which at least some general conclusions can be inferred.
“The multi-faceted nature of diabetes requires an assessment of lifestyle, behaviour, genetics and epigenetics, and the intrauterine environment,” said Jeffrey I. Mechanick, Director of Metabolic Support and Clinical Professor of Medicine at the Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York. “The problems of one country are not only relevant for that country; information gleaned from a portfolio of countries may generate emergent ideas to solve the complex diabetes problem globally.”
How was the study conducted?
The recommendations are based on the opinions of experts in each country, who were asked to describe the unique challenges and opportunities they faced. The experts looked a wide range of factors and their potential influence on type 2 diabetes care in that country, including infrastructure, culture and socioeconomics. They described how their country currently attempts to address rising rates of type 2 diabetes, and how successful these attempts have been. They also described how technology is used, the prevalence of blood glucose testing, attitudes towards doctors, religious beliefs and linguistic or communicational factors – and much more besides.
Analysing these reports, the researchers pulled together a general picture of common challenges and opportunities.
Dr. Mechanick explained: “Not surprisingly, diabetes prevalence rates are increasing the most in rural and low-middle income areas. Cultural differences also have an influence. The lack of guidelines for different target populations and also the interactions of acculturation to Westernised lifestyle with a genetic susceptibility, especially in aboriginal populations, is of concern. Clearly, understanding the effects of one culture in one country can assist diabetes care for patients of the same culture but in another country.”
The recommendations
The final report provides both region-specific case studies and an aggregated view of global type 2 diabetes care. Nations with high (and rising) rates of type 2 diabetes were commonly challenged by: a high economic burden of type 2 diabetes, a lack of funding for diabetes care, insufficiently detailed data on type 2 diabetes, a lack of government interventio, and an absence of evidence-based national guidelines.
The researchers used this data to create a set of three fundamental recommendations:
1. Nations must develop a strong base of evidence and data to establish who is at a high risk of type 2 diabetes. They then need to develop guidelines for diagnosis and prevention.
2. Each nation needs to invest resources in education and research, in order to fine-tune their prevention and diagnosis guidelines.
3. Nations must make it a priority to acquire the resources they need to enact their guidelines. These resources can include drugs, diagnostic tools or other supplies.
“The three recommendations serve as a starting point to address the complex nature of global diabetes care – to treat populations and individuals, to recognise similarities and differences, and to move more quickly than ever, as the diabetes epidemic has thus far been deaf to our calls for action,” said Dr. Mechanick.
The findings are published in Annals of Global Health.

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