GENERAL

• Global diabetes burden:
  • As a result of population aging and growth, rise in obesity, unhealthy diets, and sedentary lifestyle, the prevalence of diabetes is increasing rapidly worldwide, and is expected to double by 2030. Most of this increase will occur in developing countries (see epidemiology of T2DM section).
  • There are few systematic studies on public awareness of diabetes and its health and economic impacts in low- and middle-impact countries.[3]
  • Diabetes increases the risk of tuberculosis infection 3-fold and poses a significant threat to global tuberculosis control.[3][1]
• Barriers to care in resource-poor settings:[3]
  • In many developing countries, physicians may lack training specific to diabetes management. There may also be limited training of nurses dedicated to diabetes, an absence of standardized guidelines and protocols, frequent fluctuations in drug availability, and lack of health records.
  • Drug availability: Insulin is not universally accessible to all those who need it in the majority of the world, and is particularly a problem in sub-Saharan Africa. This is especially problematic for patients with type 1 diabetes in some parts of the world, if patients cannot afford necessary insulin or it is unavailable. Interruptions to general forms of cheap and/or generic oral hypoglycemic medications, such as metformin and glibenclamide, are not uncommon.
  • Drug affordability: In some developing countries, insulin is provided free in the public sector, whereas costs of one 10 ml vial of U-100 insulin can be as high as $18 USD in some countries.[2]
  • Insulin storage: There are practical issues related to insulin storage in hotter climates.
  • Cultural perceptions: In some parts of the world, being overweight or obese is perceived as marker of social success, so it can be challenging to engage patients to lose weight. There are also cultural issues regarding self-injection in some parts of the world.
  • Poor infrastructure: This includes lack of: sustainable laboratory services, patient education in nutrition and self-care, or routine monitoring and clinical care makes it challenging to treat a chronic disease that requires follow-up. Access to glucometers for self-monitoring of glucose is limited in many parts of the world.
• Worldwide diabetes initiatives:
  
  • The World Health Organization (WHO) and International Diabetes Federation (IDF) have partnered to create the "Diabetes Action Now" initiative (www.who.int/diabetes/actionnow)‎, which has the following goals:
    • To increase awareness about diabetes, its complications, and its prevention, particularly among health policy makers in low- and middle-income countries and communities
    • To support projects that define awareness about diabetes and its economic impact in low- and middle-income communities
    • Disseminate information on prevention of diabetes and its complications
    • Produce up-to-date practical guidance for policy makers in low- and middle-income countries on structure and implementation of national diabetes programs
    • Maintain a web-based resource to help policy makers implement national diabetes programs
  • World Diabetes Day is November 14th each year, devoted to global activities to raise awareness of different aspects of diabetes and its complications.
  • IDF has drafted the "International Charter of Rights and Responsibilities" of People with Diabetes: http://www.idf.org/sites/default/files/attachments/Charter-of-Rights-EN.pdf.
• United Nations (UN) Non-Communicable Disease (NCD) Summit:
  • UN convened high-level summit on the four most prominent NCDs: cancers, cardiovascular diseases, chronic respiratory diseases and diabetes in September 2011. Next high-level meeting on NCDs will be in 2018.
  • Four major NCD risk factors identified: 1) tobacco use; 2) harmful use of alcohol; 3) physical inactivity; 4) poor diet[8].
  • Summary of Recommendations to UN Member States[8]:
    • Prevention and control of NCDs should be priorities in national health strategies
    • Population-wide interventions, through regulatory or legislative actions, should be instituted to combat risk factors for NCDs
    • Surveillance frameworks that monitor key risk factors should be implemented
    • Social determinants of NCDs should be addressed
    • Non-health sectors (i.e. private sector and civil society) should be engaged[4][5]
    • International agreements should be implemented to reduce risk factors
    • Primary health care should be revitalized
• WHO global strategy on diet, physical activity, and health (http://www.who.int/dietphysicalactivity/en):
  • Achieve energy balance and healthy weight
  • Limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and eliminate trans- fatty acids
  • Increase consumption of fruits and vegetables, legumes, whole grains, and nuts
  • Limit intake of free sugars
  • Limit salt (sodium) consumption from all sources and ensure that salt is iodized
  • At least 30 minutes of regular, moderate-intensity physical activity on most days