Research and Development Agenda
The following subsections discuss the major issues for research and development.
Prevention
Well-designed community-based studies of primary prevention for type 2 diabetes are needed, especially as part of multifactorial interventions, in developing countries. Research is also needed into safer and cheaper drugs to prevent diabetes when lifestyle intervention either is not feasible or has failed. In addition, we need to know the long-term effects of diabetes prevention on CVD and other outcomes. More effective and cheaper ways to prevent the major complications of diabetes are also needed. Other areas also deserving of research include noninvasive methods for monitoring blood glucose and more effective and efficient ways of screening for prediabetes, diabetes, and early diabetes complications. Evidence of the benefits of diabetes education on outcomes is lacking, and organized research to assess effective components of diabetes education and their impact on control of risk factors and long-term outcomes should be a priority.
Epidemiological and Economics Research
Scant data are available on the future burden of diabetes and its complications in developing countries. Data on trends in and the effects of risk factors for diabetes in developing countries—obesity; birthweight; physical inactivity; television viewing; dietary factors; fast foods; socioeconomic factors; and effects of urbanization, industrialization, globalization, and stress—are also sparse. Low-cost ways to obtain such data in a standardized manner may be worth considering. More data are also needed on the costs of diabetes, the impact of the disease on quality of life, and the cost-effectiveness of various interventions in the context of developing countries (International Diabetes Federation 2003a).
Health Systems and Operational Research
Greater emphasis on translation research is needed. Well-designed and standardized studies of quality of care and outcomes will help (TRIAD Study Group 2002). Research aimed at understanding system-level complexity and finding ways to deliver chronic disease care that takes such complexity into account is also likely to yield profitable results (Institute of Medicine Committee on Quality of Health Care in America 2001).Computer models suitable for assessing cost-effectiveness and for forecasting the burden in developing countries are needed. Operational research aimed at understanding the tradeoffs and the best mix of resource allocation for diabetes and chronic disease care in developing countries is also needed.
Basic Research
Further strategic unraveling of the genetic basis of type 2 diabetes and gene-environment interactions may help explain the diabetes epidemic and provide better understanding of the pathophysiology of the disease. It may also may lead to better prevention and treatment strategies. Understanding the role of prenatal influences, especially in developing countries, may offer productive opportunities for interventions. Because of the increasing occurrence of type 2 diabetes in children, as well as the role of obesity in accelerating the onset of type 1 diabetes, further research into the typology and classification of diabetes is vital. The rapid industrialization and economic development being experienced by several developing countries may make research into the role of socioeconomic factors, urban stress, and lifestyle factors on the causation of diabetes productive.
