Diabetes is a global problem with devastating human, social and economic impact. Today more than 300 million people worldwide are living with diabetes. It is speculated that each year approximately 7 million people develop diabetes. This year marks the second year of the five-year focus on 'Diabetes education and prevention", the theme selected by the International Diabetes Federation and the World Health Organization for World Diabetes Day 2009-2013.
The campaign slogan is: "Let's take control of diabetes. Now."
For the general public and people at high risk of diabetes, the focus will be on raising awareness about diabetes and disseminating tools for preventing diabetes. For diabetics, the focus will be on disseminating tools to improve knowledge of diabetes in order to better understand the condition and prevent complications. For governments and policy-makers, efforts will focus on advocacy aimed at communicating the cost-effective implications of diabetes prevention strategies and promoting diabetes education as a core component of diabetes management and treatment.
The key messages of the campaign, developed for different target groups, are:
- Know the signs and symptoms of diabetes. Early diagnosis saves lives.
- Diabetes prevention and treatment is simple and cost-effective. Put it on top of the agenda.
- Your child could be affected. Know the warning signs. See your doctor to measure the risk.
- Enjoy an active life and prevent complications.
Diabetes is difficult. The disease imposes life-long demands on people with diabetes and their families, who have to make a multitude of decisions related to managing diabetes. People with diabetes need to monitor their blood glucose, take medication, exercise regularly and adjust their eating habits. Furthermore, they may have to face issues related to living with the complications of diabetes and may be required to make considerable psychological adjustments. As outcomes are largely based on the decisions they take, it is of paramount importance that people with diabetes receive ongoing, high-quality diabetes education that is tailored to their needs and delivered by skilled health professionals.
Without diabetes education, people with diabetes are less prepared to take informed decisions, make behavioural changes, address the psychosocial issues presented by diabetes and, ultimately, may be ill-equipped to manage their diabetes effectively. Poor management will result in reduced health outcomes and an increased likelihood of developing complications. Education is therefore of the utmost importance in the prevention of diabetes complications and central to the World Diabetes Day campaign. The role of the diabetes educator is of critical importance within the diabetes care team. The educator enables people with diabetes to manage their diabetes-related health to the best of their ability so that choices and actions are based upon informed judgement.
Most people with diabetes cannot access diabetes education due to factors such as cost, distance, and the lack of appropriate services. Many more may be unaware of the services that do exist or perhaps not convinced of the benefits that diabetes education can bring. They may feel, for example, that interaction with their physician provides all the education they need. The World Diabetes Day campaign will promote the importance of structured diabetes education programmes as key to the prevention and control of diabetes and advocate for increased opportunities for diabetes education within healthcare systems and communities.
Diabetes education is particularly lacking in developing countries. Even in developed countries, many people cannot access education because there are not enough educators or centres to cope with the rising number of people with diabetes. The International Diabetes Federation is working to identify and fill the gaps in the provision of diabetes education worldwide. In 2003, the Federation produced International Standards for Diabetes Education, which were revised and updated in 2008.
IDF’s educational framework encompasses action for change on multiple fronts, including a commitment to establishing a network of recognized IDF centres of education that can advance the development of diabetes education in every region. IDF has been involved extensively in promoting diabetes education by developing and promoting the international standards and curricula in various languages, providing education through regional associations, providing education materials, lobbying, and disseminating the evidence.
Diabetes education is best provided by a multidisciplinary team. While multidisciplinary education is available in some countries, in many others it is not available and its value is not fully recognized by the medical profession. The World Diabetes Day campaign sets out to challenge this. It is hoped that the awareness raised by the campaign will encourage healthcare systems everywhere to recognize the need to provide structured diabetes education and help establish access to skilled diabetes education as the right of every person with diabetes.
At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation. Type 2 diabetes, however, can be prevented in many cases by maintaining a healthy weight and being physically active. Studies in China, Finland and the United States have confirmed this.
Putting aside arguments over the quality of the data and methodologies employed, the last thirty years have seen a rapid increase in type 2 diabetes. In 1985, an estimated 30 million people worldwide had diabetes. A little over a decade later, the figure had risen to over 150 million. Today, according to IDF figures, it exceeds 285 million. Unless action is taken to implement effective prevention and control programmes, IDF predicts that the total number of people with diabetes will reach 435 million by 2030. It is increasingly apparent that the explosion in diabetes will overwhelm healthcare systems everywhere and subvert the gains of economic development. It is important for the diabetes world to communicate a consistent message that investment in diabetes education and diabetes prevention programmes will save money in the long term and deliver significant returns in quality of life for people with diabetes and people at high risk of diabetes.
The World Diabetes Day campaign’s approach to primary prevention is informed by the IDF Consensus on Type 2 Diabetes Prevention (2007). The consensus proposes a simple three step plan for the prevention of type 2 diabetes in those at increased risk.
IDF recommends that all people at high risk of developing type 2 diabetes be identified through opportunistic and self-screening. People at high risk can be easily identified through a simple questionnaire to assess risk factors such as age, waist circumference, family history, cardiovascular history and gestational history.
Once identified, people at high risk of diabetes should have their plasma glucose levels measured by a health professional to detect Impaired Fasting Glucose or Impaired Glucose Tolerance, both of which indicate an increased risk of type 2 diabetes. Prevention efforts should target those at risk in order to delay or avoid the onset of type 2 diabetes.
There is substantial evidence that achieving a healthy body weight and moderate physical activity can help prevent the development of type 2 diabetes. In primary prevention there is an important role for the diabetes educator to help people understand the risks and set realistic goals to improve health. IDF recommends a goal of at least 30 minutes of daily exercise, such as brisk walking, swimming, cycling or dancing. Regular walking for at least 30 minutes per day, for example, has been shown to reduce the risk of type 2 diabetes by 35-40%.
World Diabetes Day aims to promote greater awareness about the risk factors for diabetes and encourage best-practice sharing in diabetes prevention. The campaign will ask diabetes stakeholders to call on UN Member States to follow through on the promise of the UN Resolution on diabetes and develop national policies for the prevention, treatment and care of diabetes in line with the sustainable development of their healthcare systems.