Fight against diabetes just went global

Irish diabetes pioneer takes up leading international post in fight against the alarming increase in diabetes worldwide, writes MICHELLE McDONAGH

ONCE A disease associated with western obesity, diabetes has become a silent epidemic that is threatening to overwhelm global healthcare resources and wipe out indigenous populations in developing countries.

With seven million people developing the disease every year, the challenge to cure diabetes and prevent its onset has never been more urgent.

Leading the international fight against the worldwide diabetes crisis is pioneering Irish consultant endocrinologist Prof James Nolan, who has just taken up a position as chief executive of one of the world’s leading diabetes research centres – the Steno Diabetes Centre in Denmark.

In tandem with developing Ireland’s largest diabetes clinic, Nolan is best known for having built up an internationally acclaimed diabetes research department at St James’s Hospital, Dublin.

Over the past decade he and his team have been examining the early stages and mechanisms of diabetes and investigating potential new treatments for the condition.

Today more than 250 million people worldwide are living with diabetes – some 200,000 of these in Ireland – and by 2025, this total is expected to increase to more than 380 million people. Each year, more than 3.8 million people die from diabetes-related causes, one death every 10 seconds.

The two countries with the largest number of diabetics are India and China, and it is estimated that by the year 2030, seven of the 10 countries with the highest number of people with the condition will be in Asia.

There are many causes attributed to the rise of diabetes within the Asian region, but the most common are ageing populations, increased industrialisation, poor eating habits and often sedentary lifestyles.

It is against this background that Nolan has organised a major conference, Innovation in Diabetes – A Global View, which is taking take place in Dublin this weekend.

The conference will focus on new and innovative approaches to the treatment and prevention of diabetes, with leading experts in the field coming from all over the world to make presentations.

“Diabetes in Crisis was the theme of our last meeting in 2008 which focused on the enormity of the task ahead. There’s a lot of exciting work going on and this meeting will focus on the improvements and progress that has been made, and will look positively at the way forward,” says Nolan.

“It’s only through good international collaboration that we will solve the diabetes problem, and the idea of this month’s meeting is to hear what has been successful in other countries and see what we could use from this in Ireland,” he explains.

Speakers at this free event include Dr Steve Edelman, who has been living with diabetes since the age of 15 and is author of the best-selling book, Taking Control of Your Diabetes: Self Care.

Highly regarded diabetes researcher Jaakko Tuomilehto, professor of public health at the University of Helsinki, Finland, will speak about his country’s very successful diabetes prevention model.

“I think we can learn a lot from the Nordic countries. Their healthcare models are much more developed than ours and the way Finland has tackled the diabetes problem through changes in environment and lifestyle has been a big success story,” says Nolan.

“They have made a lot of very well costed changes in public spaces, building design, architecture, public transport and parks.

“It’s about public policy and I think the Finnish model is a good one for Ireland to consider as the country is a similar size to us.”

Nolan will make a presentation on the DiaMap project which has recently published a road map for the future of diabetes research and clinical care in Europe over the next 10 years – he chaired the clinical care element of the massive project which involved some 60 clinical specialists and scientists.

The DiaMap envisages a type of network for clinical trials, which would mean a person diagnosed with diabetes in an isolated rural region of Ireland, for example, could tap into a network of expertise and research with access to all of the latest treatments and trials.

“If, for example, there was a new stem cell trial starting in Stockholm for type 1 diabetes, the idea is that this trial would be put on the network so that patients all across Europe could participate,” says Nolan.

“This would help to remove borders and blockades in these trials; it’s already being done in clinical oncology and there has been a lot of good feedback from it.”

The hottest area of diabetes research is currently primary prevention of the disease through lifestyle changes, according to Nolan, with various groups, including his own in Dublin, looking into the use of early intervention with customised diet and exercise.

Researchers are also trying to identify a way to prevent people with pre-diabetes from progressing on to develop the disease.

At the last diabetes conference in 2008, Nolan was highly critical of the disastrous state of the diabetes infrastructure in Ireland. However, since then, he says, there have been some real efforts made to improve the situation here.

“We had an expert advisory group [of which he was a member] working with the HSE that sat for nearly two years and did a very good job of developing guidelines and common policy,” he says.

“The problem is that the implementation of change and structural change in particular has not happened since and this requires resources.

“There are efforts being made through the HSE and the new group headed by Dr Barry White. There are seeds of change which is good, but most Irish clinicians, including GPs, would say things are moving very slowly.

“The whole primary care network is way behind, we need a lot of resources put into primary care so that GPs have the structure and teams they need to tackle the diabetes problem.”

For diabetes patients in Ireland, Nolan comments that “some things are very good” such as the long-term illness programme which provides medicine free of charge, but there are still problems with waiting times, access and inadequate numbers of specialists and nurses.

Access for children is particularly poor and needs to be developed, he says.

When Nolan was approached by the Steno Diabetes Centre in Denmark last year to become its new chief executive, he regarded it as a fantastic opportunity and he started his new role there on January 1st.

The centre is an endocrinological, chiefly diabetological, research hospital and international teaching centre which specialises in treating and managing diabetes.

Speaking from his new office in Denmark, he remarks: “This is an unique place really, it’s a hospital with a clinic completely specialising in diabetes, but also has a research centre and a new centre for prevention and education.

“It was a big decision to leave Ireland because I was very happy there but on the scale of what’s possible, there’s quite a lot more possible here than at home.

“The centre has had a fantastic tradition and great reputation over the years, and my role as chief executive is to provide leadership and develop into the future as a leader in diabetes research and education.

“It’s a big challenge. We have the resources and skills here to help countries such as Asia and Africa where the diabetes crisis is escalating, and we hope to steer the ship internationally and make a real difference.”

Innovation in Diabetes - A Global View takes place at the Dublin Convention Centre on January 28-29th, 2011.

Interested healthcare professionals can register on innovationindiabetes.com or contact Brian Deegan of MC Events on tel: 01-6650300 or at bdeegan@mandcgroup.ie .

An open forum for diabetes patients and the public will take place at the Convention Centre on Friday, January 28th from 7pm-8.30pm.

Today more than

250 million

people worldwide are living with diabetes

200,000

of these are in Ireland

By 2025, this total is expected to increase to more than

380 million