The need for diabetes education in the developing world has never been greater as over 366 million people suffer from the disease worldwide. Finding new methods to reach the masses is crucial to combat the enormous toll on health systems in emerging nations says Project HOPE (Health Opportunities for People Everywhere).

The International Diabetes Federation estimates that, without intervention, more than 552 million people will have diabetes by 2030 and almost 80 per cent of diabetes will occur in low- and middle-income countries.

The Virginia-based Project HOPE, a global health education and humanitarian assistance organization, has been addressing the global explosion of diabetes and other chronic diseases for nearly 30 years. Expanding diabetes education which includes dynamic promotion of healthy lifestyle choices to health care professionals in places like India, China, Africa, Latin America and the United States is key to reversing the deadly epidemic of diabetes.

Founded in 1958, Project HOPE  is dedicated to providing lasting solutions to health problems with the mission of helping people to help themselves. Identifiable to many by the SS HOPE, the world’s first peacetime hospital ship, Project HOPE now provides medical training and health education, and conducts humanitarian assistance programmes in more than 35 countries.

“There’s an urgent need for more diabetes educators to reach communities still unfamiliar with how to recognize, treat and prevent the disease. We are dealing with a public health crisis in the developed and  now the developing world where millions have diabetes and millions are not properly diagnosed, millions more are at risk of developing diabetes putting businesses, communities and health systems at risk of a major productivity, financial, and resource  crisis in the future,” said Paul Madden, M.Ed., HOPE’s Senior Advisor for Non-communicable Diseases.

HOPE’s battle against diabetes began in 1998 in China, where HOPE is the only U.S. NGO administering a diabetes education programme. Today, it’s estimated that more than 92 million Chinese have diabetes and another 148 million adults are in the pre-diabetes stages.   HOPE’s diabetes programmes have grown beyond diagnosis, treatment and patient care in Chinese hospitals and now include public awareness programmes at the community level in provincial training centers throughout the country.

Based on HOPE’s Train-the-Trainer methodology, networks are now linking more than 800 hospitals and community health centers with HOPE’s diabetes training centers, educating more than 40,000 health care providers and reaching over 223,000 patients and their families through programs supported by China’s Ministry of Health and funded by HOPE’s corporate partners such as BD, Eli Lilly and Company and Philips Healthcare.

In sub-Saharan Africa, diabetes was once rare, but today it’s estimated that more than 12 million people are afflicted with the disease. In Johannesburg, the HOPE Centre recently opened in partnership with Eli Lilly to address the needs of patients at risk of developing or living with diabetes and hypertension.  

The HOPE Centre is working to increase access to diagnostic and treatment services, as well as diabetes prevention and disease management through support groups. HOPE is also tackling diabetes and other NCDs in Mexico, Nicaragua and the U.S. state of New Mexico.

In India, HOPE’s award-winning Diabetes Educator Project (IDEP) has trained more than 3,000 health professionals, including nurses, nutritionists and physical therapists to encourage healthy lifestyles and to work with physicians to provide anti-diabetic medicines and insulin therapy.  In an innovative new approach, HOPE has partnered with the Cornerstone On Demand Foundation and the Takeda Pharmaceutical Company, Ltd to extend the reach of IDEP through a new online diabetes educator course known as the International Diabetes Educator E-Learning (IDEEL) Programme  that will have the potential to reach a multitude of health care providers for years to come.

“With over 61 million diabetics in India, it’s crucial that we find new and innovative ways to reach people and to ensure that they balance their existing diabetes better and to slow the rate of growth of type 2 diabetes in rapidly urbanizing India. The IDEEL program holds great promise in this effort for India and beyond, “said Madden.

The IDEEL program is scheduled to launch early next year and will include engaging graphics, animation and interactive features make the distance learning experience interesting and effective. E-learning courses will tackle diabetes as a public health issue and focus on the basic principles of diabetes awareness, and will teach health professionals internationally how to build knowledge, develop critical thinking, counseling and communication skills.  Upon its future success in India, HOPE will expand the reach of IDEEL to other countries that also face a diabetes crisis including Brazil, Indonesia, Oman and beyond.

In the meanwhile  a  report released by the Pharmaceutical Research and Manufacturers of America (PhRMA) , patients battling diabetes and associated complication may benefit from new therapies that target key abnormalities of the pancreatic cells, increase insulin secretion without significantly reducing blood sugar, have reduced dosage, minimize painful nerve  damage and prevent diabetic kidney disease, if early research pans out.

America’s biopharmaceutical research companies currently are developing 221 innovative new medicines to help the nearly 347 million patients affected by diabetes, including India which is known as the diabetes capital of the world, the report adds.

These medicines in development – all in either clinical trials or under review by the Food and Drug Administration (FDA) – include 32 for type 1 diabetes, 130 for type 2 and 64 for diabetes-related conditions.

 Diabetes affects nearly 26 million Americans —8.3 per cent of the U.S. population—and about one-quarter are unaware they have the disease. Unfortunately, while the death rate due to diabetes is declining, the rate of new cases has been rising. The number of Americans diagnosed with diabetes has more than tripled since 1980, according to the U.S. Centers for Disease Control and Prevention (CDC).Lifestyle choices can affect this increase.

The CDC-led National Diabetes Prevention Program found that weight loss and increased physical activity in people at high risk for diabetes reduced the development of type 2 diabetes by 58 per cent in a 3-year period. Medicines can also help reduce the risk of type 2 diabetes. For example, one medicine was found in studies to lower the risk by 31 per cent.

According to the American Diabetes Association, most Americans with diabetes have type 2, in which relative insulin deficiency combines with the body failing to properly use insulin. Between five  per cent and 10 per centof Americans with diabetes have type 1, in which the body fails to produce insulin.

The medicines in the pipeline today offer hope of reducing the human toll and economic costs of diabetes. Examples of some medicines now being tested include:

• A medicine that improves  glucose-dependent insulin secretion.
• A medicine designed to inhibit an enzyme linked to diabetic neuropathy.
• A medicine to treat type 2 diabetes that may allow for once-weekly dosing.
  

While diabetes remains a formidable foe,America’s biopharmaceutical research companies are continuing their efforts to develop novel and more effective therapies to treat the disease and increase patients’ quality of life.

“Many of the human and economic costs associated with diabetes can be avoided, making improvement of patient adherence one of the best opportunities to get better results and greater value from our health care system,” said PhRMA President and CEO John J. Castellani. “This is by no means an easy task, but stakeholders throughout the health care system – including biopharmaceutical research companies – must work together to tackle this shared objective.”

Examples of new cutting-edge approaches to fight diabetes in the pipeline include a once-daily medicine that selectively inhibits the protein associated with glucose metabolism, a medicine designed to inhibit an enzyme linked to diabetic neuropathy and a medicine to treat type 2 diabetes that may allow for once-weekly dosing.

Since 1990, six new classes of diabetes type 2 medicines have been approved by FDA, giving patients and providers powerful new tools to treat the condition. America’s biopharmaceutical research companies continue to explore many different approaches to battle diabetes.

India alone has 61.3 million people living with diabetes, second to China according to International Diabetes Federation (IDF). The prevalence is expected to rise sharply for a variety of reasons, including an aging population more likely to develop type 2 diabetes, and longer lifespan among diabetes patients. If left untreated, diabetes can lead to severe health problems and complications, such as heart disease, stroke, vision loss and amputation.

The last two decades have witnessed steady improvements in diabetes management across the world. Today, most blockbuster drugs are available within a year of their global launch in countries where industry friendly policies exist.  

Improved adherence to diabetes medications can lead to better health outcomes and reduced costs. A recent study in Health Affairs projected that improved adherence to diabetes medications could avert more than one million emergency room visits and close to 620,000 hospitalizations annually, for a total potential savings of $8.3 billion annually.

In the meanwhile according to an article published in the Wall Street Journal, researchers are trying new approaches to treat Type 2 diabetes amid widespread uncertainty about the most effective therapies and concerns that current strategies might be doing some patients more harm than good.

New guidelines for treating the disease, which many experts consider a public-health crisis among millions of mostly overweight individuals, suggest doctors vary treatments depending on a patient's age, general health and even personal preferences. The recently updated guidelines recommend that doctors back away from pushing patients to get their blood sugar down to a standard targeted level. Aiming for a very low blood-sugar level might be appropriate for a younger person, for example, while older patients might do better with a less aggressive approach, according to the guidelines, published in June in the journal Diabetes Care.

Another approach gaining wider acceptance for some patients is the use of bariatric surgery, which results in dramatic weight loss. Though it comes with risk of serious complications, the operation has been shown in recent studies to lead to a rapid lowering of blood sugar, often enabling patients to go off most or all of their diabetes medicines.

Some experts also are questioning the benefits of gradually stepping up the intensity of drug therapy, a widely accepted approach that was reaffirmed in the latest guidelines. The aim is to maintain a patient's blood-sugar level while keeping up with the progressive nature of the disease. But researchers at UT Southwestern Medical Center in Dallas, for instance, argue in a recent small study that hitting the disease early and hard is better.