Editorial

www.thelancet.com/diabetes-endocrinology Vol 1 September 2013 1

Opi

fi cio

42/

Scie

nce

Phot

o Li

brar

y

For more on obesity see Lancet Series http://www.thelancet.com/series/obesity

For more on the Global Burden of Disease Study 2010 see http://www.thelancet.com/themed/global-burden-of-disease

For more on legislation to promote healthy eating in children see World Report Lancet 2013; 382: 385–86

For more on nutrition education in children see In Focus page 14

For more on the International Diabetes Federation’s estimates see http://www.idf.org/lifeforachild/the-programme

Endocrine disorders: turning towards the road less travelled“Qatar: world’s fattest country…”, “Childhood Obesity Rates in Israel Similar to United States…”, “Gulf states world ‘heavyweight’ contenders”, “Mexico Obesity Rate Knocks America Out Of Number One Spot”. This is just a selection of recent headlines about countries threatening to top the charts as the country with the highest obesity prevalence. As obesity spreads, type 2 diabetes follows closely in its wake. In the Global Burden of Disease Study 2010, diabetes (with type 2 diabetes the most prevalent) had leapt to the ninth greatest cause of death. 80% of people with diabetes live in low-income or middle-income countries, many of which are still struggling to cope with diseases of poverty: malnutrition, infectious diseases, and high maternal and neonatal mortality. Adding an inexorable rise in the prevalence of type 2 diabetes and exponential population growth into this mix could be devastating for the fragile health systems of these countries.

The knowledge that lifestyle factors are at the heart of this new scourge seems unable to turn the tide. Some patients can achieve diabetes remission through changes to lifestyle, and physicians should continue to promote such approaches. However, for most patients, eff ective, safe treatments that prevent complications are also required. For those in developing countries, it is essential that these treatments are available and aff ordable.

Prevention of obesity and type 2 diabetes will remain the most eff ective measure, and public health initiatives and strong political will are urgently needed to change the obesogenic environment. Unfortunately, there are as yet no examples of public health interventions that have proven eff ective at the population level. But it is time we stopped using the need for positive results from studies as a reason for political inertia. Politicians globally should take inspiration from the Latin American countries that have recently proposed legislation to promote healthy eating in children, and researchers should mobilise to collect data from these initiatives to ensure their widest future applicability.

Obesity and type 2 diabetes are arguably the biggest challenges for the endocrinology community at present, but other areas of the specialty are of great importance to human health and bring their success stories. It is over 100 years since insulin was discovered and 91 years since it was fi rst used, to dramatic eff ect,

in a child with type 1 diabetes. Since then, investments in new insulin analogues and delivery methods have allowed people with this condition to survive and thrive. Now, use of immuno therapy to prevent the destruction of β cells early in the disease course is on the horizon and off ers a tentative hope of cure. Juxtaposed with this optimism is the knowledge that the global incidence of type 1 diabetes is rising and many children in developing countries are dying for lack of insulin; according to the International Diabetes Federation, 80 000–100 000 children and adolescents with type 1 diabetes around the world are in urgent need of assistance.

Treatment has also improved the lives of many of the estimated 200 million people with thyroid disease in the world. Research eff orts are expanding into assessment of optimum treatment for those with subclinical thyroid disease. On the other side of the coin, action is necessary to ensure adequate iodine intake for pregnant women to prevent mental retardation in their children. It is a tragedy that, in developing countries, 38 million newborn babies each year are aff ected by defi ciency of this simple nutrient.

A success story of modern society is the survival of people into old age. But, in addition to diabetes and its complications, ageing is accompanied by disorders —eg, osteoporosis, sarcopenia, and dementia—that could have endocrine causes and treatments. Endocrinological research has already begun to unlock the pathophysiology of ageing diseases, and will undoubtedly form an important avenue of research into their prevention and treatment.

Onto this stage steps The Lancet Diabetes & Endocrinology. We will publish in all areas of clinical endocrinology, obesity, and metabolism. Our aim is to communicate the work and views that are essential to deliver eff ective public health measures and develop new treatments for endocrine disorders and their devastating complications. The world’s population is heading towards a crossroads at which diseases of poverty could potentially be left behind, but the spectre of non-communicable diseases looms in the distance. We believe that the endocrinology, obesity, metabolism, and public health communities can join forces to steer a path towards a new horizon; we hope to be your partner in the journey ahead. ■ The Lancet Diabetes & Endocrinology