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Call for action on diabetes

This year’s annual World Health Day on 7th April highlighted the dramatic rise in the prevalence of Type 2 diabetes (T2DM) and urged global action to contain the epidemic. The number of people suffering from T2DM has approximately quadrupled in three and a half decades; currently 8.5% of the global adult population is affected. Because uncontrolled, elevated levels of blood glucose can eventually result in cardiovascular disease, kidney failure, lower limb amputation and loss of sight, as well as premature death, the disease has major socioeconomic impacts in addition to health issues. Yet it is unlikely, at least in Western populations, that interventions to promote more balanced diets and less sedentary lifestyles will reduce the widespread overweight and obesity that fuels the T2DM epidemic. The general public in the West is continuously informed about the beneficial effects of healthy eating and sufficient physical exercise, but modern working environments, family commitments and social activities often preclude compliance with good health advice. And many of us, healthcare professionals included, think it’s worth taking the risk of eating and drinking (even smoking) what we really enjoy! However, advice once a subject knows that s/ he has prediabetes or T2DM, or is at higher risk because she has suffered from gestational diabetes, is much more likely to be heeded. Thus mass screening programmes are surely the most effective way of curbing the escalating T2DM epidemic.
Many studies assessing the outcome of T2DM screening have reported minimal impact on prevalence. However, some recent community-based screening projects offering testing at a variety of venues including sports grounds, shopping centres, pharmacies (and why not polling stations?) show promise. In such an approach it is clearly simpler to utilise point-ofcare capillary glycosylated haemoglobin (A1c) tests. A finger stick to obtain one drop of blood followed by a short wait in situ for a result that reflects the average blood glucose level over the past three months is clearly preferable to measuring fasting or random glucose levels, tests which require patient forethought, laboratory facilities, larger samples and frequently repeat tests. POC A1c tests are currently available for around €9 a unit, surely cost-effective if a result of prediabetes precipitates patient lifestyle changes, and a diagnosis of diabetes leads to follow-up care.
Of course one must develop clear guidelines for the follow up of subjects with positive test results but surely such screening programmes are more likely to have an effect on the T2DM epidemic than frequently overweight healthcare workers pontificating about healthy diets and exercise?