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Reversing Diabetes Trends
Missed Opportunities in Diabetes
The root of the problem of diabetes is our inability, throughout the world, to offer truly adequate care. While many excellent healthcare professionals, care policies, and treatments are available, the hard fact is that only a very small proportion of people with diabetes are able to fully benefit from them.
Diabetes is a chronic disease that takes many years to run its course. As the disease progresses, the importance of high quality treatment becomes more and more important. For a variety of reasons, quality care in many nations can be a limited resource. As a result, many suffer a far worse quality of life than they could otherwise. Earlier screenings and diagnosis could help to identify those with any form of diabetes, help these patients reach treatment targets, and substantially reduce the onset of later stage medical complications.
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The 'Rule of Halves,' developed in studies of hypertension,1,2 is a sobering lesson that can also be applied to the expected pathway of diabetes care, unless improvements are made in diagnosis and treatment. This model shows that among all people with diabetes, only 50% are diagnosed. Of those who are diagnosed, only 50% receive care, and from this group, only 50% will achieve desired outcomes. What this boils down to is that out of all people who have diabetes, only 6% will manage to live well and have successful outcomes.2
Strategy for Reversing Diabetes Trends
Increasing age, urbanisation, and obesity are the three top drivers behind the rising prevalence of type 2 diabetes in our global health economy. The drive for improvements in diabetes prevention and diabetes care requires successful change in three key areas:
- Social: Public knowledge and perception of diabetes
- Clinical: Current state of clinical outcomes and quality of diabetes care and its impact on patients
- Economic: Current state of diabetes focusing on direct and indirect costs of diabetes in regional areas and nations and promoting greater resources and support by payers and healthcare systems to support education, prevention, and treatment
Diabetes care will not be improved significantly, especially in the face of the growing pandemic, until a solid foundation of knowledge has been built about the extent and effectiveness of care today. Only when outcomes are measured and compared can weaknesses in strategies, treatment methods, and care systems be identified and improvements made.
Progress is Being Made
The call to ‘measure, share, and improve’ diabetes data can lead to increased awareness of the cost of diabetes, as well as the important role that data collection plays in reversing diabetes trends.
- Data from Clalit Healthcare Services, the largest health maintenance organisation (HMO) in Israel, showed that measuring and sharing diabetes treatment results reduced the average cost of treating people with diabetes by about 5% per year between 2001 and 2007, mainly through reduction in hospital days. In this same period, the total cost of treating Clalit’s people with diabetes was reduced by about 25%3
- National data collection systems in Sweden have increased the understanding of diabetes and have led to improvements in the care of people with diabetes, with 75% of Swedish patients with type 2 diabetes achieving HbA1c <6.5%4
- Diabetes care in the Netherlands has shown a steady improvement in glycaemic control linked with careful recording since 19974
From these examples and other evidence from countries worldwide, it is clear that reversing diabetes trends is possible, and securing commitment from key stakeholders at the global, national, clinic, and patient levels to benchmark diabetes care data is central to improving care delivery, outcomes, and healthcare expenditures.
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