Proven and effective actions to tackle diabetes

Diabetes prevention and management can be improved with strong health systems, effective policy frameworks and informed citizens

There are interventions and lifestyle changes that can improve the health outcomes of people living with or at risk of diabetes.

Living with diabetes

Although recent evidence suggests that remission of type 2 diabetes may be possible, both type 1 and type 2 diabetes should currently be regarded as lifelong conditions that require continuous self-management.

Type 1 diabetes

People with type 1 diabetes need daily injections of insulin to control their blood glucose levels. If they do not have access to insulin, they will die. Regular blood glucose monitoring and a healthy lifestyle are also required to effectively manage type 1 diabetes.

Type 2 diabetes

Priorities in type 2 diabetes management include a healthy diet, regular physical activity and maintaining a healthy body weight. Oral medicines and insulin may also be prescribed to help control blood glucose levels.

People at risk of diabetes

Type 1 diabetes

No effective and safe intervention currently exists to prevent type 1 diabetes. However, there is some evidence that a high growth rate in children is a possible risk factor, indicating that a healthy lifestyle preventing over-eating and sedentarism is recommended.

Type 2 diabetes

Healthy diet and a physically active lifestyle are the most important preventive factors for people at risk of type 2 diabetes. Clinical trials conducted over the past two decades clearly show that the prevention or delay of type 2 diabetes is possible through lifestyle modifications or administration of some pharmacological agents.

Diabetes in pregnancy

Hyperglycaemia in pregnancy (HIP) can be classified as either gestational diabetes mellitus (GDM) or diabetes in pregnancy (DIP). Both can lead to increased risk of subsequent diabetes in the mother and pre-disposition during the life of the unborn child. Regular check-ups are recommended for mothers-to-be as part of regular antenatal appointments.

Impaired glucose tolerance and impaired fasting glucose

Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are conditions where blood glucose levels are above the normal range and below the recommended diabetes diagnostic threshold. The terms 'prediabetes', 'non-diabetic hyperglycaemia', 'intermediate hyperglycaemia' are also used as alternatives.

The importance of IGT and IFG is three-fold: they signify a risk of developing type 2 diabetes in the future; they denote an already heightened risk of cardiovascular diseases; and their detection opens the door to interventions that can lead to the prevention of type 2 diabetes.

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National policies and strategies

Governments must adopt multisectoral approaches to respond to the diabetes challenge

There are some promising NCDs 'best buys' recommended by WHO and backed by robust evidence. These include the imposition of taxes on sugar-sweetened beverages, placing detailed labelling on food packaging, and the development and implementation of education and awareness campaigns (including on media) to foster physical activity in the community. The solutions that work in one place may not be as effective in another, so policies and prevention programmes must be tailored for each country and coordinated across all sectors involved.

Universal health coverage (UHC), as proposed by the World Health Organization (WHO), aims "to ensure that all people obtain the essential health services they need without suffering financial hardship when paying for them." Health systems must ensure that diabetes is included in the services provided as part of the UHC package of essential services, and each country needs to align these services with its technical and financial resources. Primary healthcare staff should be trained to recognise the symptoms of diabetes, perform and interpret diagnostic tests and provide quality treatment and care.

Universal health coverage

Health systems must ensure that diabetes is included in the services provided as part of the UHC package of essential services, and each country needs to align these services with its technical and financial resources.

The entry point for diabetes care should be at the primary healthcare level, which provides both preventive and curative services within communities and close to individuals throughout their lifespan, ensuring effective health monitoring, diagnosis and care. This also ensures that all aspects of the individuals receive care, and not just their diabetes.

Diabetes care is multi-dimensional, as a result of the complex interactions between environmental, lifestyle, clinical and genetic factors. Each person has a unique profile of risk factors and complications, and access to continuing care, education and medication strongly influence the clinical course. An integrated partnership between health professionals and people living with diabetes should safeguard the health and well-being of all patients and their families.

With regard to the issue of access to medicines, the WHO Model Essential Medicines Lists prioritise prioritize metformin, gliclazide and human insulin over newer and more expensive treatments. IDF also considers glucometers, needles and test strips as essential supplies for people with diabetes.

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Tips for advocates: Setting objectives that "join the dots"

After gathering evidence, establishing partnerships, identifying priorities and assessing your country's progress against international commitments, you need to set your advocacy goal and objectives.

Ideally, your objectives should be achievable through the implementation of effective and proven actions, such as the ones described in this section.

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