Diabetes: An Update on the Pandemic and Potential Solutions

Diabetes mellitus is a chronic metabolic disease with deadly, disabling, and costly consequences for individuals, families, communities, and countries. Although they are phenotypically distinct, diabetes subtypes (type 1, type 2, gestational, and other forms) are all defined by elevated blood glucose levels. Approximately 95 percent of diabetes cases worldwide are type 2 diabetes (previously known as adult-onset or non-insulin-dependent diabetes), which is the focus of this chapter. Type 1 diabetes (previously known as insulin-dependent diabetes) most commonly begins in childhood and adolescence. Gestational diabetes refers to elevated blood glucose levels during pregnancy among women without previous diabetes and is associated with fetal, birthing, and early childhood complications as well as higher risk of the mother developing postgestation diabetes. The growth of diabetes and its impacts have accelerated worldwide since the end of the twentieth century (NCD-RisC 2016), likely correlated with expansion of diabetes risk factors, especially population aging and obesity. Diabetes is a multifactorial condition. Because genetic, epigenetic, lifestyle, economic, and psychosocial factors all contribute to the development of diabetes (McCarthy 2010; Stumvoll, Goldstein, and van Haeften 2005), preventing and managing the condition require action at policy, program, clinical practice, and individual levels (Hill and others 2013). Reliable and meaningful estimates of burdens, risk factors, and effectiveness and cost-effectiveness of interventions as well as evaluations of existing policies, are limited; data are especially scarce in lowand middleincome countries (LMICs). This chapter focuses on what can and should be done to address diabetes. We present the available data regarding global burdens and trends in diabetes; review available evidence and assess the effectiveness and cost-effectiveness of interventions to prevent, detect, and control diabetes; and report summary expert opinions regarding the priority and feasibility of implementing these interventions. Assimilating evidence from countries at different income levels, we provide global perspectives on the diabetes pandemic, recommend priority interventions, and identify remaining data gaps.