Prevention of T2DM: International networking

At the United Nations High Level Meeting for Non Communicable Diseases (NCD) in September 2011 in New York, Ministers of Health asked for international cooperation and policy decisions on diabetes according to the present context of globalization of health issues[1]. There was a consensus across countries that national plans for prevention and control of chronic diseases be developed and implemented and that strategies to monitor progress on implementation be established. In May 2012 the European Diabetes Leadership Forum was held, hosted by the OECD and the Danish European Presidency to discuss developing strategies on political, medical and patient centered level for improving diabetes prevention and care. Kofi Annan said at the meeting “There is no other option than to act – we have not enough money not to prevent diabetes.” Key actions to improve the quality of diabetes care worldwide are seen as 1. implementation of diabetes prevention programs, 2. development of chronic care management programs in primary care, and 3. development of monitoring instruments and quality management strategies for diabetes prevention and care [2]. International networking has to become the key for the successful investment into diabetes prevention activities.

International activities IMAGE and DE-PLAN

Type 2 diabetes can be delayed or prevented among people who have IGT with lifestyle interventions or medication as shown by major clinical trials of diabetes prevention. However it is difficult to translate this message derived from the lifestyle trials to clinical practice [3]. We are still learning how this challenge may be achieved at a population level. Optimally, every person with a diabetes risk has the chance of having access to any kind of diabetes preventative initiative [4].

Two international European funded Projects DE-PLAN [5] and IMAGE [6] have been addressing the implementation process. Especially the IMAGE project was able to collate available information in a systematic manner and developed practical relevant standards for diabetes prevention. A group of about 100 European experts in this field has worked for 2.5 years, to prepare the main deliverables of the projects, which are the Evidence-based guideline on T2D prevention [7], a Toolkit for diabetes prevention [8] and a guideline for evaluation and quality indicators and management in T2D prevention [9]. Furthermore a European training curriculum for prevention managers to perform diabetes prevention intervention programmes was developed [10]. These initiatives build the basis for the implementation in many additional countries outside Europe. The strength of the IMAGE deliverables were the free availability and the chance to modify the content to meet local conditions.

Network “Who are Active in Diabetes prevention”

An important current new initiative is the start of an international network “Who are active in diabetes prevention”. The aim of this network is that people, who are interested in the prevention of diabetes and those, who want to start activities in the field meet in one professional network. The network itself encourages exchanging knowledge, recent intervention material as well as educational standards. The most important focus of the network is the exchange of experiences in diabetes prevention practice. It is also thought as a platform for scientific information and up-to-date study information between research groups and people active in diabetes prevention. People from more than 147 countries are already part of the network. Especially many participants are coming from low and middle income countries. The informations and support by this platform is of great practical help for increasing knowledge and for initiating diabetes prevention programs accomapied by quality management. Everyone who is interested prevention of type 2 diabetes is invited to register for free and benefit from this global network – www.activeindiabetesprevention.com [11].

Global Diabetes Survey

To enhance the capability to develop and implement National Diabetes Prevention and Management Programs it is planned to perform a Global Diabetes Survey, which annually will report about the degree of implementation of national diabetes plans worldwide. For this purpose, a representative group of experts from different sectors of diabetes care, including patients, is going to be consulted as volunteers in a structured and standardized way. The survey will be arranged online and will cover a standardized and structured assessment about a realistic view on diabetes on a national level. The answers will be analyzed to display the situation of national diabetes plans for the individual countries. Everyone who is associated with diabetes care is invited to participate as a volunteer www.globaldiabetessurvey.com [12]. The European results for the year 2012 showed a huge variability of the rating of quality of diabetes care within European countries. Moreover, affected people tended to rate the quality of delivery in different fields of diabetes care lower than care providers. The Global Diabetes Survey will provide a unique opportunity to establish a primary care-based monitoring instrument to assess the realistic situation for prevention and care of diabetes in order to improve the performance of national diabetes plans and to increase the quality of prevention and care of diabetes.

As estimated by the International Diabetes Federation, the number of T2D patients is likely to increase during the forthcoming years. There is a need to continue systematic research in aetiology, prevention and care management of T2D. In particular, translational research regarding the implementation of existing knowledge into public health and clinical practice must be carried out. International networking is a stimulating source to exchange scientific and practice ideas and to transfer knowledge to the place were an optimal added value for implementation can be generated. The international network “Who are active in diabetes prevention” and the “Global Diabetes Survey” generates networks and scientific evidence by involving people from daily practice all over the world. By working together we can develop the future of T2D prevention– it is time to act now.

References

  1. ^ Keeling, A., The UN Summit and beyond: a new era for diabetes. Diabetes Res Clin Pract, 2011. 94(1): p. 163-5.

  2. ^ Schwarz, P.E., Newsletter 6.2012 - European Diabetes Leadership Forum Report - 25.-26. April 2012 in Copenhagen, Denmark. Network Active in Diabetes Prevention, 2012. 3(6): p. 5.

  3. ^ Schwarz, P.E. and J. Lindstrom, From evidence to practice--the IMAGE project--new standards in the prevention of type 2 diabetes. Diabetes Res Clin Pract, 2011. 91(2): p. 138-40.

  4. ^ Schwarz, P.E., et al., Nonpharmacological interventions for the prevention of type 2 diabetes mellitus. Nat Rev Endocrinol, 2012.

  5. ^ Schwarz, P.E., et al., The European perspective of type 2 diabetes prevention: diabetes in Europe--prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project. Exp Clin Endocrinol Diabetes, 2008. 116(3): p. 167-72.

  6. ^ Schwarz, P.E., et al., The European perspective on diabetes prevention: development and Implementation of A European Guideline and training standards for diabetes prevention (IMAGE). Diab Vasc Dis Res, 2007. 4(4): p. 353-7.

  7. ^ Paulweber, B., et al., A European evidence-based guideline for the prevention of type 2 diabetes. Horm Metab Res, 2010. 42 Suppl 1: p. S3-36.

  8. ^ Lindstrom, J., et al., Take action to prevent diabetes--the IMAGE toolkit for the prevention of type 2 diabetes in Europe. Horm Metab Res, 2010. 42 Suppl 1: p. S37-55.

  9. ^ Pajunen, P., et al., Quality indicators for the prevention of type 2 diabetes in Europe--IMAGE. Horm Metab Res, 2010. 42 Suppl 1: p. S56-63.

  10. ^ Kronsbein, P., et al., IMAGE - Development of a European curriculum for the training of prevention managers. Br J Diabetes Vasc Dis, 2011. 11(4): p. 163-167.

  11. ^ Schwarz, P.E. and A.L. Albright, Prevention of type 2 diabetes: the strategic approach for implementation. Horm Metab Res, 2011. 43(13): p. 907-10.

  12. ^ Schwarz, P.E., et al., Global Diabetes Survey--an annual report on quality of diabetes care. Diabetes Res Clin Pract, 2013. 100(1): p. 11-8.

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