trans-fats from the food supply is feasible, inexpensive and vital. Making sure that all pregnant women and infants get adequate nutrition and basic medical care will also prevent diabetes, obesity and cardiovascular disease, among many other good and long-lasting effects, and this is feasible and probably cost-saving for society, as well. However, apart from tobacco and


salt control, which work immediately, primary prevention takes decades or even generations to show an effect, and for this and other reasons (low impact, limited reach) the World Health Organization estimates that primary prevention can only prevent a small proportion of future diabetes, strokes, heart attacks, and so on. Also, at least 30 million Middle Easterners already have diabetes. So to me the most urgent priority is secondary prevention, making sure all those with diabetes are identified and getting the proven low risk medicines and education that can reduce their risk of death and bad medical events by 50% to 75%. Since the safest and most proven medicines are also by far the least expensive, basic secondary prevention will also save medical care costs, according to many studies and official estimates. Given these facts, it would be a crime not to do it. Sensible secondary prevention should be done, and done quickly, regardless of what else is done to prevent diabetes.


Q. What needs to be done on a government level in order to prevent diabetes from increasing at the current rate? A. I have already mentioned the primary prevention interventions that can work: maternal and infant nutrition and medical care, taxing and controlling tobacco and poisonous and unhealthy foods, and public education about all these things. In the long run, these actions will reduce the rate of diabetes growth but realistically they will not prevent most diabetes. Government can also look for


people with ‘pre-diabetes’ and offer them behaviour-change programmes and medicines. These programmes have been proven to delay diabetes in many studies but, unfortunately, at least in the United States, only a small percentage of eligible people want to sign up for them, and most of those who do sign up


eventually regain their weight. So these programmes are worth offering but they will not be enough to stop the epidemic.


Q. What’s new in diabetes research and how will these effect future policies? A. Hundreds of billions have been invested recently in new pills for diabetes, new insulins, new glucose monitoring devices, new heart disease prevention pills, and new surgical procedures, as well as in research on diabetes genetics, physiology, and so on. Honestly, almost all of these investments have failed to make much difference. The new pills and insulins are either not as good, or not appreciably better than the old treatments, and most of them have turned out to have serious side effects. New treatments are also very costly. Scientific understanding of diabetes has increased dramatically but no gene has been found that explains a very large amount of diabetes or cardiovascular disease, and there has been no dramatic improvement in our ability to detect who will get diabetes and who will not. And sadly, recent randomized trials have found that getting blood sugar very low in diabetes, near to normal, and getting blood pressure very low, 


144 www.lifesciencesmagazines.com


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