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Diabetes prevention requires multiple concerted strategies

Changing people’s lifestyle is an important step towards diabetes prevention

Diabetes is one of the largest global health emergencies of the 21st century. On a global scale, there are an estimated 415 million people aged 20-79 with diabetes. These include 193 million who are undiagnosed. A further 318 million adults with impaired glucose tolerance are also at high risk of developing the disease. In 2015 alone, diabetes and its related complications will have caused 5 million deathsand cost 12% of the global healthcare spend.

How can we slow, stop, or reverse the diabetes epidemic?

While some risk factor such as ageing are unavoidable, type 2 diabetes treatment, reversal, and prevention must focus on ‘changeable’ risk factors. Particularly, the adoption of healthy nutrition, increased physical activity, and maintenance of a normal body weight. These healthy lifestyle behaviours could reduce all new cases of type 2 diabetes by as much as 65-80% according to the World Health Organisation.

 Of course, diabetes management and prevention cannot be left to patients alone. Much can be done by policy makers, businesses, and civil society to build physical and cultural environments conducive of healthy habits. Re-designing cities, public spaces and work spaces to encourage physical activities, for instance by ensuring that work-places, schools and shops are well-connected to residential areas through cycle lane and pedestrian walkways, that there are a sufficient number of green areas and pedestrian areas, that air-pollution is under control and that stairs are as easy to spot as elevators, could strongly contribute to contain the diabetes 2 epidemics.

Are public and private institutions doing enough in this regard? How much should they invest? Can they afford not to? How do you measure the benefits?

Universalistic approaches to balanced nutrition have proved effective in some EU Countries, so for instance in Finland, where school children, students and employees all receive free or subsidised low-fat meals at school or in the workplace, socioeconomic inequalities in the use of butter and high-fat milk have remarkably declined.

Tailored approaches, aiming at making healthy food more attractive to children for examples, have also proved successful: the LazyTown TV programme and mobile application created in 1996 in Iceland to lower obesity rates in children and young people was very successful. Between 27% and 42% of pre-school children in a trial felt that LazyTown branded food tasted better than identical non-branded food.

Many questions remain: what is the best nutrition for preventing diabetes? What is the best way to inform and encourage ‘health literacy’ at school, work, and home? Should policymakers legislate against unhealthy food products and adverts at the national or EU institutional level? How can we include socio-economically disadvantaged groups – who are most at risk of diabetes – in management and prevention initiatives?

Greater knowledge of the societal constructs underpinning diabetes could certainly help design more effective interventions. For example, the Cities Changing Diabetes project brings together pharmaceutical companies, universities, third sector organisations, and policy makers from 11 cities around the world to address the rise of diabetes in urban centres. To do so, it is mapping the extent of the condition, understanding its social, economic and cultural drivers and is sharing and implementing effective approaches to collectively overcome this challenge. The project team found that diabetes in Mexico City is associated with stress, and particularly long commutes, exploitation, social insecurity, and delinquency. By contrast, diabetes in Shanghai is strongly stigmatised and associated with weakness and old age.

Despite better awareness and new developments in the management and prevention of diabetes, there has been an unrelenting increase in the number of people with diabetes over the past 50 years. Prevalence of diabetes is increasing steadily among all ages, both among men and women, mainly due to increases in overweight and obesity, stemming from unhealthy diet and physical inactivity. So what we can do to stop this epidemic?

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