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World Diabetes Day: Integrated Preventive Care is Worth the Investment

November 12, 2015
Andrea Feigl
Andrea Feigl
Associate, International Health   Dasha Migunov
Dasha Migunov
Associate, International Health The 2014 International Diabetes Foundation’s Diabetes Atlas paints a bleak picture: 1 in 12 people worldwide live with type 2 diabetes, and half of them do not know that they are diabetics. When they do find out, the disease is very advanced, leaving a large human and financial toll, including amputations, loss of sight, and the inability to stay economically productive.

In 2014, global spending on diabetes reached US$ 612 billion – one in nine healthcare dollars worldwide. However, the lack of prevention, under-diagnosis, and resulting high healthcare costs and productivity losses pose a challenge to global and national economies. One systemic review, for example, suggests that early investments in prevention would be “particularly worthwhile.”

Abt Associates joins a wide global community in calling attention to these issues on World Diabetes Day, observed on November 14. But we are not only talking about diabetes, Abt JTA is working in Fiji to better integrate diabetes screening into the Fiji health system so that fewer people suffer complications, including loss of sight and limbs.

Integrated Diabetes Care

Early diabetes detection and prevention need to be coupled with system-level changes to be effective and sustainable. However, most current international development programs, even those that focus on health systems strengthening, do not include diabetes and chronic disease related programs, despite the United Nations’ Sustainable Development Agenda, which includes ensuring well-being for all ages.

The Western Pacific has the highest number of people living with diabetes – 138 million – and the highest rate of undiagnosed diabetes: 53.6 percent. The Fiji Health Sector Support Program (FHSSP), funded by the Australian Government and managed by Abt JTA, is perhaps one of the few projects globally, supported by bilateral donors, which takes integration to heart.

FHSSP is addressing Fiji’s high rate of diabetes-related complications through prevention-focused interventions that are integrated in the health system and rely on the support of community health volunteers.

The project’s diabetes prevention and foot care initiatives enables diabetics to successfully manage their condition and provide for their families. FHSSP worked with the Fiji Ministry of Health and Medical Services (MoHMS) to revise diabetes screening guidelines and train nurses and dieticians to begin a national screening program. This program now is fully funded by the MoHMS with screening rates and identified cases reported quarterly. The sustainability of FHSSP support to this intervention is becoming evident in the screening results being reported by the MoHMS. With 15 percent of the target population screened to date, the MoHMS is on track to achieving its screening target of 25 percent in 2015.

A positive result of the screening process is that more than 80 percent of those screened and identified as diabetic received on the spot behavior change counselling, exceeding the 2015 target of 75 percent. Ultimately, these interventions are contributing to the dramatic reduction in the national amputation rate for diabetic foot sepsis, from 47 percent to 15 percent.

Challenges to Address 

While there is an increasing focus on diabetes programs in low-and middle income countries (LMICs) through development projects and national programs, including the HealthRise project in India, Brazil, South Africa, and the U.S., – in which Abt also is a partner – funding and project numbers for diabetes in LMICs is dwarfed by vertical, infectious disease related projects.

The health development community needs to come together as a whole to tackle sustainable change at the systems level, with a particular focus on non-communicable diseases and diabetes prevention and control. If business as usual continues, the economic toll by 2030 will be more than US$ 47 trillion, in addition to the human toll.
Read more about Abt’s work relating to diabetes and other non-communicable diseases:  
Read more about global diabetes:
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