Editorial

It was hard not to notice the announcement at the

71st American Diabetes Association (ADA) meeting in
San Diego, CA, USA (June 2428): one in four US adults
now has diabetes. For the fourth year in a row, we
dedicate an issue of The Lancet to this global disease, in
collaboration with the ADA.
On June 25, we published a paper by Goodarz Danaei
and colleagues reporting that the rate of diabetes
worldwide has reached an alarming proportion. The
199 country analysis, which included 27 million
individuals, estimated that the number of adults with
diabetes has doubled within the past three decades
up from 153 million in 1980 to 347 million in 2008.
Although 70% of the observed increase is attributed to
population growth and ageing, the number also reects
the unfortunate global shift towards a western lifestyle
of unhealthy diet and physical inactivity, with obesity as
the outcome.
Obesity is a prominent risk factor for type 2 diabetes,
and with global obesity rates rising, the ensuing
burden of type 2 diabetes looks set to worsen. Earlier
this year, Mariel Finucane and co-authors reported
in The Lancet that there are already an estimated
146 billion overweight and 495 million obese
adults worldwide. Between 1980 and 2008, agestandardised mean global body-mass index increased
by 0405 kg/m per decade in men and women.
Perhaps what is most disturbing is that childhood
obesity rates are also increasing. In the USA, 10%
of infants and toddlers already carry excess weight,
and more than 20% of children between the ages
of 2 years and 5 years are overweight or obese.
These data come from the US Institute of Medicines
Early Childhood Obesity Prevention Policies report
released on June 23, 2011. The report focuses on
nutrition, physical activity, and sedentary behaviour
within the rst 5 years of life, and places the
responsibility for ensuring a healthy lifestyle for
children on people involved in their early lives: childcare providers, educators, parents, and health-care
workers. The report seems to be a good step in the
right direction for promotion of life-long behavioural
interventional approaches such as limiting time spent
watching television and providing diets rich in fruit
and vegetables.
www.thelancet.com Vol 378 July 9, 2011

The ACTID trial, in todays issue, shows that dietary

advice given in a primary-care setting, with or without
an increase in physical activity, can prevent a decline in
glucose control in adult patients with type 2 diabetes.
The benet of this simple intervention to achieve a
successful lifestyle adjustment draws attention to the
importance of patient education. Studies are warranted
to see whether the same intervention can achieve similar
successes when applied to parents of, and children with,
type 2 diabetes.
Benets are also seen when individuals are better
informed about diabetes risk factors and early disease
symptoms, which put emphasis on primary prevention,
screening, and early intervention. Since many
non-communicable diseases share common risk factors,
such as poor diet and a sedentary lifestyle, primary
prevention of diabetes should be included in broader
non-communicable disease prevention strategies. A
multidisciplinary health-provider team eort is an ideal
approach for diabetes detection and management.
As Jean Claude Mbanya, President of the International
Diabetes Federation, puts itthere must be a shift
from the present disease-focused care approach
towards one that is patient-focused. In low-income
and middle-income countries, this means integration
of communicable and non-communicable disease-care
strategies. The goal should be saving and prolonging
lives by refocusing of care at the patient level.
By 2030, the number of individuals with diabetes
worldwide is expected to rise to 472 million, almost
80% of whom will be in low-income and middle-income
countries. In these regions, diabetes drugs and insulin
are often inaccessible or are too expensive, and the local
health-care systems do not have the personnel and
nancial capacity to cope. This situation must change.
Today, diabetes represents a much more complex
issue than just insulin control, as stated by past ADA
President Richard Bergenstal. The High-Level Meeting
of the UN General Assembly on the Prevention
and Control of Non-Communicable Diseases in
September this year, presents a unique chance to
galvanise support for the creation and implementation
of global and local health policies to address the current
pandemic of diabetes. It is an opportunity that should
not be squandered. The Lancet

Reuters

The diabetes pandemic

See Articles page 129

For the worldwide diabetes

rates for 2008 see Articles
Lancet 2011; 378: 3140
For the worldwide diabetes
estimates for 2030 see www.
diabetesatlas.org
For the IOM report on early
childhood obesity prevention
policies see http://www.iom.
edu/Reports/2011/EarlyChildhood-Obesity-PreventionPolicies.aspx

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