Details

Autor(en) / Beteiligte

• Chan, Juliana C N
• Lim, Lee-Ling
• Wareham, Nicholas J
• Shaw, Jonathan E
• Orchard, Trevor J
• Zhang, Ping
• Lau, Eric S H
• Eliasson, Björn
• Kong, Alice P S
• Ezzati, Majid
• Aguilar-Salinas, Carlos A
• McGill, Margaret
• Levitt, Naomi S
• Ning, Guang
• So, Wing-Yee
• Adams, Jean
• Bracco, Paula
• Forouhi, Nita G
• Gregory, Gabriel A
• Guo, Jingchuan
• Hua, Xinyang
• Klatman, Emma L
• Magliano, Dianna J
• Ng, Boon-Peng
• Ogilvie, David
• Panter, Jenna
• Pavkov, Meda
• Shao, Hui
• Unwin, Nigel
• White, Martin
• Wou, Constance
• Ma, Ronald C W
• Schmidt, Maria I
• Ramachandran, Ambady
• Seino, Yutaka
• Bennett, Peter H
• Oldenburg, Brian
• Gagliardino, Juan José
• Luk, Andrea O Y
• Clarke, Philip M
• Ogle, Graham D
• Davies, Melanie J
• Holman, Rury R
• Gregg, Edward W

Titel

The Lancet Commission on diabetes: using data to transform diabetes care and patient lives

Ist Teil von

• The Lancet (British edition), 2020-12, Vol.396 (10267), p.2019-2082

Ort / Verlag

England: Elsevier Ltd

Erscheinungsjahr

2020

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• The strengthening of existing infrastructures to provide continuing integrated care and the creation of career paths for physicians with knowledge and skills to reorganise diabetes care, train non-physician personnel, and use technology effectively can improve the accessibility, sustainability, and affordability of diabetes prevention and care By revisiting the definition of an epidemic, we explain how the concept of environment–agent–host interactions, which is often used to explain marked variations in risk exposure and outcomes in communicable diseases, also applies to diabetes, in which ecosystem and human behaviours are key upstream factors. Despite the availability of efficacious medications proven to reduce cardiovascular–renal events and death rates in clinical trial settings, their scarce provision and access to trained health-care providers, together with inefficient care organisation, have prevented the translation of evidence-based, risk-reducing therapies to clinical practice in most care settings. On the basis of best evidence and practices, we summarise the benefits of more effectively managing multiple risk factors in patients with diagnosed diabetes whereby (1) sustained weight reduction in patients with obesity by 15 kg or more can induce remission of type 2 diabetes for up to 2 years; (2) reducing glycated haemoglobin A1c (HbA1c) by 0·9% (10 mmol/mol), systolic blood pressure by 10 mm Hg, or LDL cholesterol concentration by 1 mmol/L (39 mg/dL) can independently reduce the risk of cardiovascular disease, all-cause death, or both, by 10–20% in patients with type 2 diabetes; (3) reducing multiple risk factors, including by use of statins and renin–angiotensin system inhibitors, can prevent cardiovascular–renal events by 20–40% in individuals with or at risk of having diabetes; (4) use of SGLT2 inhibitors and GLP-1 receptor agonists can reduce cardiovascular–renal events and death rates by up to 40%, independent of their effect on lowering blood glucose concentration; (5) use of data-driven, team-based integrated care through the reorganisation of health-care provision can reduce cardiovascular and all-cause death in patients with type 2 diabetes by 20–60%; and (6) implementing a structured lifestyle intervention and use of metformin can each prevent or delay type 2 diabetes in individuals with impaired glucose tolerance by 30–50%. To translate these evidence-based strategies for reducing risk of diabetes and its complications, we put together an implementation plan showing that by training non-physician personnel to form diabetes teams, health-care providers can redesign workflow and use information and communication technology to set up diabetes registers, and use the data collected to empower self-management, improve provider–patient communication, and reduce multiple risk factors.