BARCELONA — Physicians and other health care workers should use clinical consultations to identify all individuals at high risk of developing type 2 diabetes, according to an International Diabetes Federation (IDF) consensus statement released at an international congress on prediabetes and metabolic syndrome.
Speaking at a press conference to mark the report's launch, Dr. Paul Zimmet, director of the International Diabetes Institute, Melbourne, stressed that renewed advocacy is needed to combat worldwide projected increases in diabetes, which he labeled “the largest and fastest-growing disease epidemic in history.”
“Since the 1980s, the number of people with diabetes has grown threefold. … With 246 million people with diabetes now and 380 million people with diabetes [predicted] by 2025, diabetes is set to bankrupt national economies,” warned Dr. Zimmet. And if numbers of people with impaired glucose tolerance, or prediabetes, are added to that sum, the at-risk population swells to 800 million by 2025, he said.
The IDF consensus recommends a two-pronged approach to prevention aimed at halting the rise in diabetes and associated conditions, targeting both at-risk individuals and the whole population. Central to the high-risk approach is to identify the target group, explained Dr. George Alberti, senior research fellow at Imperial College, London, and coauthor of the IDF statement. However, he said, this is “difficult because so many people won't have any obvious signs.”
The one external feature that does indicate high risk of diabetes is waist measurement. “The easiest way for most people is to look and see if they can see their feet,” Dr. Alberti said. The IDF suggests that this method should be the main one used by resource-poor countries to identify their at-risk populations, but physicians can also use validated questionnaires to assess risk status.
Once suspicion of risk is identified, explained Dr. Alberti, physicians should then measure blood glucose in their patients to identify existing undiagnosed metabolic syndrome or diabetes. This group can then be targeted with interventions to induce lifestyle changes and increase weight loss. “It is easy. Eat less and walk more,” Dr. Alberti said.
Population-wide efforts need to focus on national plans, he added. Governments must support the idea of healthy lifestyle education in schools, encouraging people to walk around more, and leaning on the food industry to act responsibly when it comes to advertising its products. However, he said, nongovernmental organizations and charities have an important role to play in raising awareness of the issue.
“It is about getting the [nongovernmental organizations] and the diabetes organizations to keep prodding away at the government. The key is repetitive actions,” he said. “There is no point in saying something once to politicians; you have to say it over and over again.”
The IDF calls for all countries to adopt national diabetes prevention plans that bring together strategies for prevention, secondary prevention, and treatment of diabetes as associated disorders. Stressing that healthy environments are key to achieving population-wide behavior change, Dr. Jean-Claude Mbanya, president-elect of the IDF and vice dean of the faculty of medicine and biomedical sciences, University of Yaounde, Cameroon, said a key feature of these plans should be collaboration between all government sectors, including health, education, sports, and agriculture.
Avi Friedman, Ph.D., professor of architecture at McGill University, Montreal, who supports the IDF call for a broad view on health improvement, said, “Inadvertently, our own government authorities may have contributed to this epidemic by allowing developers to create urban social problems. … Urban sprawls are part and parcel of new developments without proper attention to building design, sidewalks, bike paths, public transport corridors, playing fields, and friendly exercise areas that are essential and need to be accessible to people who want to maintain a healthy lifestyle.”