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Global evidence indicates a constant and progressive rise in the prevalence of diabetes, particularly in its most commonly diagnosed form: type 2 diabetes. The diabetes “pandemic” affects all countries and in Latin America, we must consider the rising prevalence in a broader context of delayed diagnosis and poor treatment outcomes related to the quality of care provided to people with diabetes (1).

Experts attribute the rise to characteristics typically associated with modern living, such as sedentary lifestyles, consumption of high-calorie foods, lack of sleep, continuous stress, poverty and low levels  of education. Other contributing factors include a lack of trained healthcare professionals and little political will in terms of preventative measures and policies (2).

Data from the field, however, suggest a slightly different picture. They indicate that strategies implemented to control the rising prevalence of type 2 diabetes have not proven sufficiently effective. It may, therefore, be necessary to consider a different and broader approach. To help consider this, let’s take a closer look at each of the factors mentioned above.

Sedentarism: modern societies promote this unhealthy habit by facilitating easy access to everything we need, without requiring us to burn calories. Schools contribute by not giving physical education the priority it requires. At an age when people acquire their personal habits, children are simply not learning the importance of exercise.

Low levels of education and poverty: these are two independent factors that increase the prevalence of type 2 diabetes.

Consumption of high-calorie foods: when are we taught the principles of a healthy diet? Even in some medical schools, nutrition is not a major part of the syllabus. What then can we expect at the lower levels of education available to the majority the population? Achieving beneficial changes requires effective collaboration between the Ministries of Health and Education. It would be advisable for these Ministries to develop a common education plan that incorporates the basic principles of a healthy diet for the general population, and introduces related courses into the school curriculum from primary school. It would be important to involve nutrition specialists from Faculties of Medicine in the development of this plan. Another important topic that will need to be considered is the role of the food industry and whether it should be part of the solution and, if so, what level of involvement should it be allowed.

At an age when people acquire their personal habits, children are simply not learning the importance of exercise.

Continuous stress: modern society promotes stress. One example is the constant use of mobile devices. We are informed constantly of the dangers of over-use of these devices. However, are we, as physicians, solely responsible for this? This question implies collaboration with other sectors of society to promote more healthy use of mobile devices without adversely affecting our habits and customs.

Lack of sleep: this is a related point largely associated with new digital forms of communication, work and entertainment habits. Is it not now time to involve those who regulate or promote these conditions in the discussion?

Poverty: throughout the world, low-income levels are associated with a higher prevalence of type 2 diabetes and obesity. It has also been shown that type 2 diabetes and its associated complications  establish a vicious circle in which poverty generates diabetes and diabetes increases poverty by reducing access to higher education and quality employment (3). This issue obviously goes beyond the remit of Ministries of Health. The Economy and Social Development or Welfare Ministries must also contribute to developing and implementing effective solutions.

Medical research and education: the continuous advance of medical knowledge is a result of the association between research and the communication of its results by academics. It is likely that research, without reducing its efforts in the clinical/molecular area, should simultaneously investigate the causes of real world problems and identify effective solutions. In parallel, academic institutions should continue to teach both clinical findings and real-world issues to future health professionals in a balanced way. This will help achieve our goal of reducing the significant impact of non-communicable diseases on individuals and societies.

ALL those concerned by the impact of diabetes and obesity should be brought together to find effective solutions to tackle and reduce their impact.

A serious, but not directly related, consequence of what has been described above is the issue of job discrimination that many people with diabetes encounter, alongside gender inequalities. Only an inter-sectoral and multi-stakeholder discussion can find solutions to discrimination in the workplace.

In conclusion, I believe it is relevant to repeat the phrase, included in the title of this article, coined by Alexandre Dumas in his well-known novel, The Three Musketeers. ALL those concerned by the impact of diabetes and obesity should be brought together to find effective solutions to tackle and reduce their impact. Scientific meetings and congresses should open their doors to the official inclusion of interdisciplinary and inter-sectoral forums. Perhaps such an approach would help us achieve our long-aspired-for goal of reducing the social and economic impact of the diabetes pandemic.

This article was originally published in Rev ALAD 2018; 8:55.


  1. Fraser L-A, Twombly J, Zhu M et al. Delay in Diagnosis of Diabetes Is Not the Patient’s Fault. Diabetes Care. 2010; 33 (1): e10).
  2. Gagliardino JJ, Aschner P, Baik SH, Chan J, ChantelotJ-M, Ilkova H, A Ramachandran A, IDMPS investigators. Patients’ education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Diabetes Metab 2012;38:128
  3. Elgart JF, Caporale JE, Asteazarán S, De La Fuente JL, Camilluci C, Brown JB, González CD, Gagliardino JJ. Association between socioeconomic status, type 2 diabetes and its chronic complications in Argentina. Diabetes Res.Clin Practice 2014;104 (2): 241.


Juan José Gagliardino, CENEXA (UNLP-CONICET.CEAS CIC PBA), Facultad de Ciencias Médicas UNLP, La Plata, Argentina

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