The lead Editorial in this week's American Diabetes Association meeting Special Issue of The Lancet describes the global type 2 diabetes epidemic as a public health humiliation. It calls for a response that recognizes the limits of drug treatment and uses a range of interventions embracing physical activity.
While the drug advances reported in The Lancet this week are welcome, they will probably only end up being available in developed countries. More than two thirds of patients with diabetes worldwide live in developing countries, and thus these nations need interventions that are low-cost and easy to implement. The Editorial highlights that "medicine might be winning the battle of glucose control, but is losing the war against diabetes."
The Editorial says: "Because type 2 diabetes, which accounts for 90% of diabetes, is largely rooted in reversible social and lifestyle factors, a medical approach alone is unlikely to be the solution. Moreover, medicalisation disempowers individuals and excludes communities, schools, and urban planners who have the potential to reduce diabetes incidence... health professionals who care for people with diabetes have an enormous opportunity to build collaborations with different agencies that seek similar outcomes."
The Editorial endorses the Let's Move campaign headed by US First Lady Michelle Obama. Her approach involves three components: nutrition, activity, and children. As well as diets with less fat and sugar, urban recreation must be readily accessible, affordable, and include safe areas for youngsters, whose requirement for exercise is greater than that of adults. The Editorial says: "The focus on youth in a disorder that is age-related might seem paradoxical; but the age of diabetes onset is falling and it is in young people that diet and exercise habits are formed. It is also at a young age that the seeds of diabetes are sown—one in three children over the age of 2 years in the USA is overweight and one in six adolescents is obese. For those who are obese in childhood, type 2 diabetes in adolescence and premature mortality in later life are more common."
It concludes: "Diabetes need not be an inevitable consequence of urbanisation or social inequity, nor should future generations be condemned to perpetuate diabetogenic lifestyles. The fact that type 2 diabetes, a largely preventable disorder, has reached epidemic proportion is a public health humiliation. A strong, integrated, and imaginative response is required, in which the limits of drug treatment and the opportunities of civil society are recognised. The ADA meeting offers world leaders in diabetes an opportunity to reflect on the above challenges and initiate debate on a more inclusive and effective strategy to control diabetes."
The Lancet Press Office T) +44 (0) 20 7424 4949 E) tony.kirby@lancet.com
For full Editorial, see: http://press.thelancet.com/editorials2606.pdf
Journal
The Lancet