Approach transforms diabetes care from detection to cure
Europe’s approach to diabetes care stands at a crossroads. The International Diabetes Federation Europe brought together patients, doctors, scientists, and policymakers in December to map out where treatment is falling short—and what can be done about it.
The scale of the problem
Diabetes prevalence continues to climb. Projections show that by 2050, six more million people—bringing the total to 72 million, will live with the condition, reflecting a worrying trend that shows the urgent need for action. One in three people remain undiagnosed, left unaware of their condition and potentially at higher risk of complications. Around half of those diagnosed fail to meet their treatment targets, indicating a significant gap in current care strategies.
The consequences of inadequate management are severe. Without proper control, patients face an array of life-altering complications, including nerve damage, kidney disease, and even amputations. Access to new medicines, technologies, educational resources, and screening services varies widely across and within European countries, leading to disparities in care. The fragmentation of health system delivery further exacerbates these challenges, hindering efforts to provide full, coordinated care.
Preventing and reversing type 2 diabetes
Traditionally viewed as a progressively worsening condition, type 2 diabetes is now understood to be more dynamic and potentially reversible in some cases. Emerging evidence supports the use of lifestyle interventions, such as low-energy diets and increased physical activity, coupled with medication and even surgical procedures like bariatric surgery, to prevent or reverse the condition. For instance, the DiRECT trial showed that weight loss through a low-calorie diet and regular support can achieve remission in some people with type 2 diabetes.
Continuous glucose monitoring (CGM) devices play a key role in managing diabetes. These wearable or implantable sensors track glucose levels in real-time, facilitating early detection of hypoglycemia or hyperglycemia, guiding intervention choices, and helping patients and healthcare professionals visualize and respond to glucose patterns. However, the full potential of these devices is yet to be realized due to barriers such as inconsistent early detection, inadequate follow-up support, and a lack of awareness about their benefits.
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Overcoming these obstacles requires a multi-pronged approach. Improving access to CGM devices and ensuring timely intervention following diagnosis are key. Ongoing follow-up and support before and after remission are essential to maintain progress and prevent relapse. Additionally, a shift in mindset is needed among both healthcare professionals and patients, who must adopt the possibility of preventing or reversing type 2 diabetes, rather than viewing it as an inevitably progressive condition.
Diabetes as the root cause of other conditions
Diabetes is a complex disease that often goes hand in hand with other chronic conditions. Dysglycemia, the abnormal blood sugar level that characterizes diabetes, heightens the risk of cardiovascular diseases, kidney disease, liver disease, retinopathy, neuropathy, and more. One in three people with diabetes develops cardiovascular disease, and one in three develops kidney disease, highlighting the interconnected nature of these conditions.
A holistic, joined-up approach to screening, early detection, and management is vital to tackle this web of conditions effectively. New diabetes therapies now offer benefits beyond glucose control, protecting the heart, kidneys, and liver. For example, SGLT2 inhibitors have shown promise in reducing the risk of cardiovascular and kidney complications in patients with type 2 diabetes. However, further research is needed to determine the optimal usage of these agents for people living with type 1 diabetes and to develop new solutions for cardio-renal protection in this population.
Integrating care requires a restructuring of health systems to deliver person-centred care as the foundation of chronic disease management. By doing so, healthcare systems can identify complications earlier, reduce premature mortality, and lessen the burden of living with multiple long-term conditions. Collaboration among healthcare providers, researchers, and policymakers is essential to achieve this goal and improve the lives of millions of people affected by diabetes and its related conditions.
Pathways toward better care
Scientific progress in diabetes is accelerating, offering hope for a future where people with type 1 diabetes no longer rely on insulin injections. Advances in cell and gene therapies, including cell replacement, gene editing, and cell regeneration, hold great promise for this population. For instance, stem cell-based therapies and gene therapies targeting the insulin-producing beta cells could potentially cure type 1 diabetes.
