#Diabetes Prevention: Not Sexy– but Essential

Enjoy this superb article by Medscape’s Christine Wiebe

Andrew Boulton, MD, is feeling “cynical” about the global diabetes scourge. But as soon as he admits that, he changes his description to “realistic.”

Andrew Boulton, MD

“We’re in an epidemic, and it’s getting worse,” says the immediate past president of the European Association for the Study of Diabetes (EASD). In Pakistan, for instance, 1 in 4 people has diabetes, and in India, the prevalence has doubled in the past 15 years, he says. He places some of the blame on the “McDonald’s-ization of the world,” plus society’s aversion to walking and cycling in favor of driving cool cars.

“I wonder if legs will still be needed in the future,” he says wryly.

At the annual meeting of the EASD, held recently in Lisbon, Portugal, the big news was about clinical trials of new drugs or new uses for older drugs, and particularly about the arrival of diabetes medications that not only control glucose but also offer some cardiovascular and renal protection for people who use them. Dr Boulton was EASD president when the first such drug was validated at this conference 2 years ago, and he has witnessed great improvements in diabetes care over the course of his career. Yet, he remains skeptical.

“It’s great to have new drugs,” he says, “but we also need to be more active in primary prevention.”

Dr Boulton’s frustration with a lack of progress in stemming the international diabetes epidemic is evident, and he’s not the only one.

Last year, at the annual meeting of the American Diabetes Association, then-president Desmond Schatz, MD, delivered an impassioned speech about the “staggering” prevalence of diabetes and about the need for improvements in diagnosis and treatment, along with increased funding for research.

Studies show that about one half of all type 2 diabetes cases could be prevented with lifestyle adjustments, Dr Boulton notes. But the burden of prevention shouldn’t be placed on individuals alone.

“We need societal adjustments as well,” he says. Cities and buildings need to be designed in ways that encourage healthier lifestyles, such as improving public transportation and walking paths. Advocacy organizations, such as the International Diabetes Federation, need to be more proactive in advancing the diabetes agenda.

“They need to be heard; they need to be seen!” Dr Boulton says. Right now, governments still don’t take diabetes very seriously, especially compared with the attention and funding dedicated to cancer. Leaders of the diabetes community could learn from efforts to raise awareness and drive research in the field of cancer, he said, as well as from efforts to increase cancer screening.

“Fear arousal works,” he says. Many more people now get mammograms and other cancer screenings because they don’t want to die of cancer.

Unfortunately, prevention and screening are harder to “sell” with diabetes.

“The thing is, it’s not very sexy to take off your socks and shoes,” Dr Boulton says, referring to diabetic foot exams.

“But it works. You don’t need anything expensive to screen. The most important thing is to look at the eyes and the feet. And it’s the same with the kidney; you just need a urine test,” he continued.

“We’re talking about very simple tools that can be used in primary care that everyone with diabetes should have done once a year. And that would have a huge impact and would reduce costs by trillions of dollars each year.”

Everyone knows these things, Dr Boulton says, but it’s still tempting to instead focus on a novel drug that reduces the desire for sweets, for example.

“We can talk about all this fancy new stuff, but we’ve got to do the basics first,” he said.

As he contemplates the proliferation of restaurant food buffets, and valet service that keeps customers from walking even a short distance from their cars, Dr Boulton’s cynicism resurfaces.

The end of the EASD meeting signals the start of another year for more education and advocacy for diabetes prevention and care.

“Maybe I’ll be more optimistic a year from now,” Dr Boulton says unconvincingly.

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Follow Christine Wiebe on Twitter: @CWiebeMedscape

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