A solution might be within people with diabetes themselves

In 10 minutes, by the time you finish reading this editorial, 60 people with diabetes will die and 120 people will be diagnosed with diabetes worldwide. As tragic as the death of so many people is, the doubling of people with the same illness, an illness we have not learned how to manage and one that can be prevented in the first place, represents a failure of the world health system of apocalyptic proportions. Two hundred and fifty million people diagnosed with diabetes today will grow to nearly 400 million by 2025. As dramatic as this quantitative analysis is, qualitative considerations make this global suffering unsustainable and unacceptable. The burden of diabetes is the greatest in the developing world, where some 80% of people with diabetes live. Unfortunately, more than 80% of expenditures for medical care for diabetes are made in the world’s economically richest countries. The world spends about USD 250 billion to treat and prevent diabetes and its complications. One country alone, the US, spends more than half of this amount (www. IDF.org). In spite of this robust expenditure, only 7.3% of people with diabetes in the US achieve recommended levels of glucose, cholesterol and blood pressure control simultaneously (www.cdc.gov). This cannot be explained only by health disparities, since far more than 7.3% of US adults with diabetes enjoy access to quality health care. Rather it is a reflection of the complexity of managing diabetes as well as other chronic diseases, of which diabetes is an important example. There is no doubt that more resources are needed in countries of the developing world for the care of people with diabetes, but it is also clear that expenditures and investments do not guarantee satisfactory outcomes. Alternative hypotheses for the care of people with diabetes must be put forward and tested if we are to modify the course or predicted prevalence, morbidity and burden of diabetes. One such hypothesis is the focus of this supplement of Family Medicine. A World Health Organization (WHO) consultation on peer support programmes in diabetes was convened in November 2007 and published in July 2008 at www.who.int/diabetes/publications/en/. Participants were experts in peer support frommore than 25 countries, representing all regions of the world. The proceedings of this conference and the original scholarly background papers supporting the conference are published herein. As background to all of these, this editorial answers three questions: Why was the WHO consultation convened? What were the conclusions and recommendations? and How will implementation of these recommendations provide part of a solution (not necessarily the solution) to the global burden of diabetes? The premise of the WHO consultation and the projects that will follow from it is that people living with diabetes have a great deal to offer one another in terms of behavioural and emotional support. People with diabetes need more thanmedical treatment from their health-care providers: they also need support in mastering and sustaining complex self-care behaviour that enables them to live healthy and satisfying lives while managing their diabetes 365 days a year for the rest of their lives. That people living with diabetes have much to offer each other is reflected in a wide range of research. A recent study of the determinants of medical outcomes in Type 2 diabetes demonstrated that patient-level factors accounted for the majority of variability in haemoglobin A1c (98%) while physician-related factors accounted for a very small portion of metabolic control. An earlier review of self-management programmes found that the only characteristic predictive of metabolic control was the amount of time spent between the health-care professional and the patient. These two findings suggest development of patientlevel interventions that entail ongoing support and follow-up for those with diabetes to support their efforts at disease management. Peer mentors may be identified and trained to provide this kind of patientlevel support to assist others in need. If effective, the peer support model would be a promising addition to public health systems that face severe resource constraints and increasing needs among patients living with diabetes and/or other chronic diseases. Reflecting the hope that peer support might be part of the solution to worldwide diabetes, the Lilly