Focus on Diabetes 1
Type 2 Diabetes: The 'AIDS' of the 21st Century?
MONTREUX, SWITZERLAND, 29 May 2002 - The International Diabetes Federation (IDF) has called for urgent action to stem the growing epidemic of type 2 diabetes by identifying those at high-risk, and to prevent complications by more aggressive management of blood glucose control.
A key message was that many physicians have been too complacent about the need for tight blood glucose control. This complacency has been passed on to patients, who are often poorly motivated to control their condition. "Type 2 diabetes is not a 'mild' form of diabetes," said IDF President, Professor Sir George Alberti, speaking at a Federation meeting in Montreux. "More aggressive control of the whole blood glucose profile is essential if we are to prevent the life-threatening complications of diabetes."
Diabetes remains the industrialized world's leading cause of blindness, end-stage renal disease, and non-traumatic limb amputations. Type 2 diabetes increases the risk of cardiovascular diseases by two or three fold, and eight out of ten people with the condition will die from a cardiovascular disease.
The key to preventing diabetic complications is to achieve tight control of blood glucose as well as meticulous control of other cardiovascular disease risk factors.
The U.K. Prospective Diabetes Study showed that if HbA1c (a marker of blood glucose control) is reduced by 1%, the risk of heart attack is reduced by 14%, and the risk of eye and kidney damage by up to nearly 45%. Yet the vast majority of patients with type 2 diabetes do not achieve adequate control of their blood glucose levels, particularly their post-meal glucose.
Early detection of the condition is also vital. "Affluent nations should be screening high-risk groups, such as people who are obese, have a family history, or are from ethnic groups pre-disposed to the condition," said Professor Alberti.
Earlier detection and treatment would not only reduce the suffering caused by diabetic complications, but would reduce the huge burden that diabetes places on healthcare services. Type 2 diabetes already accounts for 10-15% of European healthcare budgets and this is set to rise.
It is essential that more resources be devoted to diabetes prevention programmes. Unless significant efforts are made to stem the rise in diabetes, healthcare services across the world will soon be crippled by the costs of treating the diseases and its complications.
"Diabetes could become the AIDS of the 21st century," warned Professor Alberti. "The importance of diabetes prevention cannot be underestimated."
Type 2 diabetes currently affects 1 in 20 European adults (22.5 million). A further 1 in 7 adults over 40 years of age have a condition known as impaired glucose tolerance (IGT), which confers a high risk of diabetes and a significantly increased risk of cardiovascular disease. Approximately half of people with IGT will develop diabetes within ten years, but the vast majority of people with IGT will never be diagnosed, or offered advice on how to reduce their risk of progressing to diabetes.
Recent large-scale clinical trials have shown that frequent lifestyle advice, delivered by a health professional, is effective at reducing diabetes incidence in people at high risk. Clinical trials are also underway to investigate whether drugs that improve insulin secretion or insulin sensitivity reduce the risk of diabetes and cardiovascular disease in high-risk groups. The largest of these is the NAVIGATOR trial launched in November 2001, which will involve 7,500 people with IGT in 41 countries across the world.
Professor Alberti called for people with impaired glucose tolerance to be managed much more aggressively with lifestyle change and weight control and drug therapy for lifestyle advice failures.
IDF website: www.idf.org
- World Health Organisation (1999). Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus.
- Diabetes Atlas 2000. International Diabetes Federation.
- King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025. Diabetes Care 1998; 21: 1414-31.
- American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000; 23: 381-89.
- Donnelly R, Emslie-Smith AM, Gardner ID, Morris AD. Vascular complications of diabetes. British Medical Journal 2000; 320: 1062-6.
- Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595-1607.
Posted: May 2002