Primary prevention of type-2 diabetes in developing countries.
Primary prevention of type-2 diabetes in developing countries.
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DOI：
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发表时间：
2006-03
影响因子：
3.3
通讯作者：
S. Dagogo-Jack
中科院分区：
文献类型：
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作者：
S. Dagogo-Jack
虽然糖尿病现在是一种世界性流行病，但其在发展中国家的流行率上升速度令人震惊。到2025年，超过四分之三的糖尿病患者将居住在发展中国家。印度和中国正在引领糖尿病的激增，撒哈拉以南非洲目前的患病率较低。然而，在美洲、西印度群岛和整个散居地的非洲人后裔中，估计增长幅度很大。有令人信服的理由说明为什么必须在发展中国家积极努力进行糖尿病的一级预防。一旦患上糖尿病，照顾患者的费用就会令人望而却步。管理不善的糖尿病导致几种并发症（例如，终末期肾衰竭、失明、截肢和心脏病），许多发展中国家无力应对。在具有里程碑意义的试验中，生活方式改变方法在预防糖尿病方面比昂贵的药物更有效。这是幸运的，因为生活方式的改变可以在当地实施，而药物往往需要高价进口。第一项任务是教育政策制定者，使他们认识到迫切需要及时采取行动，预防糖尿病的流行。一旦政府确信其重要价值，通过饮食调整和增加身体活动来预防糖尿病将需要仔细规划，广泛试点和创造性地分配稀缺资源。在发展中国家实施广泛的糖尿病预防计划几乎肯定需要外部支持、外国援助、债务减免和其他形式的创造性融资。
Although diabetes is now a worldwide epidemic, the rate of increase in its prevalence in developing countries is alarming. By the year 2025, more than three-quarters of all persons with diabetes will reside in developing countries. India and China are leading this surge in diabetes, and sub-Saharan Africa is currently at a lower prevalence rate. However, the estimated increase is substantial among African descendants in the Americas, West Indies and throughout the diaspora. There are compelling reasons why aggressive efforts must be directed toward primary prevention of diabetes in developing countries. Once diabetes develops, the cost of caring for patients is prohibitive. Poorly managed diabetes leads to several complications (e.g., end-stage renal failure, blindness, amputation and heart disease) that many developing countries are ill equipped to tackle. In landmark trials, lifestyle modification approaches are more efficacious than expensive medications in the prevention of diabetes. This is fortunate because lifestyle modification can be implemented locally, whereas medications often need to be imported at high cost. The first task is the education of policymakers on the urgent need for timely action to prevent the looming epidemic of diabetes. Once governments become convinced of its critical value, the translation of diabetes prevention through dietary modification and increased physical activity would require careful planning, extensive piloting and creativity in the allocation of scant resources. External support, foreign aid, debt forgiveness and other forms of creative financing will almost certainly be needed to implement widespread diabetes prevention programs in developing countries.