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

Abstract

2020 will go down in history as the year when the globalcommunity was awakened to the fragility of humanhealth and the interdependence of the ecosystem,economy, and humanity. Amid the COVID-19 pandemic,the vulnerability of people with diabetes during a publichealth emergency became evident by their at least2 times increased risk of severe disease or death,especially in individuals with poorly controlled diabetes,comorbidities, or both. The disease burden caused byCOVID-19, exacerbated by chronic conditions likediabetes, has inflicted a heavy toll on health-care systemsand the global economy.In this Lancet Commission on diabetes, which embodies4 years of extensive work on data curation, synthesis, andmodelling, we urge policy makers, payers, and plannersto collectively change the ecosystem, build capacity, andimprove the clinical practice environment. Such actionswill enable practitioners to systematically collect dataduring routine practice and to use these data effectively todiagnose early, stratify risks, define needs, improve care,evaluate solutions, and drive changes at patient, system,and policy levels to prevent and control diabetes andother non-communicable diseases. Emerging evidenceregarding the possible damaging effects of severe acuterespiratory syndrome coronavirus 2 on pancreatic isletsimplies the potential worsening of the COVID-19 pandemic and the diabetes epidemic, adding to the urgency of these collective actions.Prevention, early detection, prompt diagnosis, andcontinuing care with regular monitoring and ongoingevaluation are key elements in reducing the growingburden of diabetes. Given the silent and progressivenature of diabetes, it is epidemiological analyses thathave provided a framework for identifying populationsand subgroups at risk of diabetes and its complications.Although the total prevalence of diabetes reflects diseaseburden, incidence rates might reflect the effects ofinterventions among determinant factors that include,but are not limited to, political, socioeconomical, andtechnological changes within a population, area, orboth.In 2019, 463 million people had diabetes worldwide,with 80% from low-income and middle-income countries.Over 70% of global deaths are due to non-communicable diseases, including diabetes, cardiovascular disease, cancer, and respiratory disease. On average, diabetesreduces life expectancy in people aged 40?60 years by4?10 years and independently increases the risk of death from cardiovascular disease, renal disease, and cancer by 1·3?3·0 times. Diabetes is among the leading causes ofnon-traumatic lower extremity amputation and blindness,especially in people of working age. The co-occurrence ofthese morbidities severely impairs quality of life, reducesproductivity, and causes major suffering.