By K.M. Venkat Narayan, Justin B. Echouffo-Tcheugui, Vishwanathan Mohan, and Mohammed K. Ali ANALYSIS & COMMENTARY Global Prevention And Control Of Type 2 Diabetes Will Require Paradigm Shifts In Policies Within And Among Countries ABSTRACT Continued increases in the prevalence of and disproportionate health spending associated with type 2 diabetes argue for policies focused on preventing that condition and treating it appropriately, even as we strive to improve coordination of care for coexisting chronic diseases. This article argues that four policy paradigm shifts will be necessary to achieve that specific emphasis on type 2 diabetes: conceptually integrating primary and secondary prevention along a clinical continuum; recognizing the central importance of early detection of prediabetes and undiagnosed diabetes in implementing cost-effective prevention and control; integrating community and clinical expertise, and resources, within organized and affordable service delivery systems; and sharing and adopting evidence-based policies at the global level. D iabetes is a large, growing, and costly health problem. There are 25.8 million people with diabetes in the United States and an esti- mated 285–366 million globally, 95 percent of whom have type 2 diabetes. 1–3 Even conservative scenarios project that US diabetes prevalence will increase 50 percent by 2050, 4 while in low- and middle-income countries, the increase will be 69 percent by 2030. 2 In 2010, diabetes-related health spending worldwide to- taled US$376 billion, corresponding to 12 per- cent of all health spending and US$1,330 per person spent on diabetes. 5 Although the challenges may seem over- whelming, we argue that much can be done to stem the burdens imposed by diabetes through effective and innovative policies. In particular, much could be accomplished through evidence- based and cost-effective primary and secondary prevention of type 2 diabetes and its compli- cations. 6 In this article we argue that there are compel- ling reasons to focus specifically on type 2 dia- betes prevention and control even within the larger context of addressing noncommunicable diseases that share risk factors, such as physical inactivity and diet. More important, we contend that successfully addressing diabetes burdens will require embracing four hitherto under- appreciated paradigms. First, the primary and secondary prevention of type 2 diabetes should be integrated within a clinical continuum. Second, the importance of early detection of prediabetes and undiagnosed diabetes should be recognized as a means of catalyzing effective interventions for diabetes and associated vascular risk factors. Third, com- munity and clinical expertise and resources should be integrated within organized and af- fordable systems to deliver proven preventive and treatment services for diabetes. And finally, type 2 diabetes should be understood as a prod- uct of globalization that requires both global cooperation and the adoption of evidence-based policies at the broadest level. doi: 10.1377/hlthaff.2011.1040 HEALTH AFFAIRS 31, NO. 1 (2012): 84–92 ©2012 Project HOPE— The People-to-People Health Foundation, Inc. K.M. Venkat Narayan (knaraya@emory.edu) is the Ruth and O.C. Hubert Chair of Global Health and Epidemiology as well as a professor of medicine at Emory University in Atlanta, Georgia. Justin B. Echouffo-Tcheugui is a postdoctoral research fellow at the Rollins School of Public Health, Emory University. Vishwanathan Mohan is the director of the Madras Diabetes Research Foundation, in Chennai, India. Mohammed K. Ali is an assistant professor of global health at Emory University. 84 Health Affairs January 2012 31:1 Global Prevention & Control Downloaded from HealthAffairs.org on May 25, 2020. Copyright Project HOPE—The People-to-People Health Foundation, Inc. For personal use only. All rights reserved. Reuse permissions at HealthAffairs.org.