Diabetes: An Update on the Pandemic and Potential Solutions
Authors: Mohammed Ali, Karen Siegel, Eeshwar Chandrasekar, Nikhil Tandon, Pablo Aschner Montoya, Jean Claude Mbanya, Juliana Chan, Ping Zhang, KM Venkat Narayan
The worldwide growth in diabetes and its impacts over the last half century compel us to act. Diabetes is a chronic progressive disease, leading to damage of the eyes, kidneys, heart, brain, blood vessels, nerves, and limbs and the associated morbidity and mortality are associated with high healthcare expenditures and lost productivity. A robust base of high-quality evidence, mainly conducted in high-income countries, has shaped diabetes prevention and management guidelines and practices over the past few decades. Considerable gaps remain, however, in terms of: harmonizing support for a focused and consistent screening guideline, generating local evidence to adapt preventive and management interventions for varied settings, and in terms of estimating what resources inputs are needed and what value they provide. Our synthesis of available epidemiologic, efficacy, effectiveness, and cost-effectiveness research show that very few data originating in low- and middle-income countries are available to inform decision-makers; and most of the data are from studies focused on individual-level interventions, with very few empirical data that have examined societal-level environmental and policy interventions to address diabetes. Through a Delphi survey of experts from around the globe, we noted consensus in the priorities for diabetes detection, prevention, and care, as well as overwhelming support for more surveillance, engagement, and implementation science research to inform policies and practices going forward. The scientific, clinical, program, and policy agendas to address diabetes loom large and this multi-sectoral approach is essential to curbing the growing burdens of this multi-factorial condition.