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    Worldwide diabetes epidemic approaches half a billion

    What in the world, literally, are we going to do about the diabetes pandemic? This multifactorial problem requires multifaceted solutions targeting myriad etiological factors.

    Though focused lifestyle interventions like the Diabetes Prevention Program (150 minutes of walking per week with the goal of losing five to seven percent of body weight) have been shown to delay the onset of diabetes significantly in high-risk patients, most of these subjects ultimately developed diabetes within 15 years of this intervention.1 Moreover, there is only limited evidence for implementing these strategies and changing bad outcomes in real-world settings.2

    Although some medications decrease the risk of diabetes (e.g. metformin, pioglitazone, and weight-loss drugs), they can have significant side effects and may not be effective long-term.3

    In fact, some evidence suggests population rates of diabetes and death from diabetes decline when economic downturns have forced people to eat less food (due to both scarcity and higher costs).4,5

    There is no single magic bullet.

    Short of major global recession (God forbid), there are several possibilities that make sense:

    • Laser-focused community education about healthy lifestyle choices beginning at an early age

    • Meaningful economic incentives to exercise and to design our communities, schools and workplaces to promote physical activity

    • Massive economic incentives to produce and eat a variety of genuinely nutritious foods and in moderation (following Michael Pollan’s great advice—that is, eat real food, not too much, mostly plants)

    • Significant, collaborative, and cooperative multinational and multidisciplinary environmental change (both “carrots” and “sticks”) to reduce factors determined to be reasonably contributory by the body of scientific evidence.

    To this end, we need public advocates, we need leadership, and we need to wake up—the sooner the better.


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