On World Diabetes Day Nov 14, The Lancet publishes a Commission on diabetes that calls for a transformation of societies and health systems in order to close gaps in diabetes prevention, care, professional knowledge, and data.
The Commission report is the product of 4 years of work by 44 international experts in public health, clinical care, epidemiology, and health economics to critically reflect on progress and develop evidence-led recommendations.
From the outset, the Commission recognised that the diabetes epidemic is driven by an interwoven set of structural factors including poverty, inequality, ageing, poor nutrition, food insecurity, low educational attainment, and environmental pollution. Effective interventions exist for reducing morbidity and mortality from diabetes, but the Commission found that their use is scarce in most cases. Barriers to provision and access are compounded by the often fragmented care pathways for the complex and multiple health needs of many people with diabetes. This is especially true in low-income and middle-income countries (LMICs), where around 80% of people with diabetes live.
The COVID-19 pandemic has intensified these structural challenges and has clearly exposed the synergies between NCDs, infectious diseases, and broader social, economic, and commercial determinants of health.
The Commission says people diabetes have a two to three times increased risk of severe COVID-19 (including death) compared with individuals without diabetes, and this risk is exacerbated by poor glycaemic control, diabetes-related complications, and social conditions in disadvantaged communities that lead to lower access to care and higher rates of comorbidities.
The recommendations-
A multicomponent, integrated strategy is needed, involving the redesign of clinical workflows and training of non-physician personnel to form diabetes teams.
As well as improving patient care-systematic collection of data during routine clinical practice to improve the quality of electronic medical records and to establish registers for surveillance, prevention, and treatment. Modelling done by the Commission found up to 800 000 premature deaths could be averted by improving diabetes diagnosis, support for management of cardiometabolic risk factors, and access to essential medicines.
Comprehensive care for type 1 diabetes—insulin access, patient education, and blood glucose monitoring—could prevent 12 000 deaths each year in people younger than 25 years.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32412-0/fulltext