Each year since 1991, we pause on November 14 to reflect on how diabetes affects people living with this disease and those who love them. We are saddened each year to learn of the unprecedented increase in prevalence of both type 1 and type 2 diabetes, and more recently astonished by the numbers of individuals living with prediabetes. Another reality of the rise in cases is of course, that these numbers may not capture all those affected as many do not have access to healthcare. In the 1990s, both the World Health Organization (WHO) and the Centers for Disease Control and Prevention declared diabetes as a significant non-communicable disease of epidemic proportion and identified it as a major public health problem. Unfortunately, 20 years later, fueled by the epidemic of obesity, the call for action is even more imperative.
The WHO continues to promote awareness and understanding of the burden of this disease, not only with the “celebration” of World Diabetes Day each year, but also in 2016 the theme for World Health Day – a global health awareness day celebrated every year on 7 April – was “Beat Diabetes”. Beat it we must: the alarming rate of diagnosis is only the tip of the iceberg. While we have made significant improvement in the prevention, detection, and management of complications, we need to continue to educate not only people living with diabetes but healthcare professionals worldwide on the damage uncontrolled diabetes can do, damage that changes not only quantity but quality of life.
Beat it we must: the alarming rate of diagnosis is only the tip of the iceberg.
While the diagnosis of diabetes increases the risk of complications, long-term research has clearly demonstrated that early control of blood glucose can reduce the incidence of the devastating complications. We are so thankful for the lessons learned from long-term trials – specifically the United Kingdom Prospective Diabetes Study (UKPDS; newly diagnosed type 2 diabetes) and the Diabetes Control and Complications Trial (DCCT) in type 1 diabetes. These trials demonstrate that early control matters, not only for the microvascular complications, but for the metabolic memory of early glucose control and the ability to significantly reduce the cardiovascular complications of diabetes.
Information gained from these and other trials regarding achieved glucose levels, blood pressure levels and low-density lipoprotein targets have helped shaped clinical practice guidelines around the world to provide a road map for those caring with diabetes, to understand the evidence behind target recommendations, and to provide a clear message for people living with diabetes. In the recent years with advances in medical therapies and technologies for the management of glucose, achieving these targets theoretically has become easier. Theoretically, because while we can identify new treatment pathways and develop designer therapies, access to these exciting new therapies is in no way universal. For many countries with high rates of diabetes and lower socioeconomic status, the learning for them is how to achieve targets using older medications while trying to avoid hypoglycemia and weight gain, side effects that we are coming to understand have a series of sequelae of their own.
The concept of a new treatment paradigm has been introduced in the last few years for the management of diabetes: achieve target HbA1c levels (what matters to us) while avoiding hypoglycemia and weight gain (what matters to patients). If we don’t achieve these treatment targets, our dialysis units will just get busier, the rate of new-onset blindness in working adults will not improve, the quality of life of patients with complications like neuropathy will continue to decline, and most importantly, our patients will continue to die of cardiovascular related events at a significantly higher rate than their non-diabetic counterparts.
This must stop! I urge you, on this World Diabetes Day 2016 to raise awareness, to advocate for better access to care and therapies, to help educate those who are affected by diabetes, whether themselves or their loved ones, to help people know their risk, and most importantly to “Beat Diabetes”. The alternative is unacceptable.