The Kathmandu Declaration: “Life Circle” approach to prevention and care of diabetes mellitus

Published:December 09, 2009DOI:https://doi.org/10.1016/j.diabres.2009.10.004

      Abstract

      Objectives

      To formulate strategies and action plans for the prevention and care of diabetes mellitus as part of the implementation of the International Diabetes Federation (IDF) United Nations Resolution (UNR) 61/225 through a unique concept of a “Life Circle” approach.

      Method

      Consensus following review of evidence available and presented at a meeting convened to achieve the objective co-chaired by the IDF President and President elect and diabetologists from several countries in the IDF regions.

      Conclusions

      The Kathmandu Declaration presents the concept of a “Life Circle” approach to prevention and care of diabetes—a continuum beginning from preconception, pregnancy, infancy and childhood to adult life in an integrated manner. Emphasis is on the benefits on entering the circle at any point and formulates guidelines that could be incorporated in any national diabetes prevention and care programme, indicating the interactive role of all known aetiological factors.

      Keywords

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      References

      1. International Diabetes Federation, Diabetes Atlas, 3rd ed., 2006. Last accessed on 4 December 2008, http://www.eatlas.idf.org.

      2. United Nations, Resolution Adopted by the General Assembly, 61/225, World Diabetes Day, 2006. Last accessed on 3 December 2008, http://www.worlddiabetesday.org/files/docs/U4D/UN_Resolution.pdf.

      3. Aetiology of type 2 diabetes: the road to consensus.
        Diabet. Voice. 2003; 48: 28-31
        • Alberti K.G.
        • Zimmet P.
        • Shaw J.
        International Diabetes Federation: a consensus on Type 2 diabetes prevention.
        Diabet. Med. 2007; 24: 451-463
        • Fraser A.M.
        • Brockert J.E.
        • Ward R.H.
        Association of young maternal age with adverse reproductive outcomes.
        N. Engl. J. Med. 1995; 332: 1113-1117
        • Lao T.T.
        • Fong Ho L.
        • Chan B.C.P.
        • Leung W.C.
        Maternal age and prevalence of gestational diabetes mellitus.
        Diabetes Care. 2006; 29: 948
        • Pickup J.C.
        Inflammation and activated innate immunity in the pathogenesis of Type 2 Diabetes.
        Diabetes Care. 2004; 27: 813-823
      4. R. Bonita, M. de Courten, T. Dwyer, K. Jamrozik, R. Winkelmann, Surveillance of risk factors for noncommunicable diseases: The WHO Stepwise Approach, Summary, Last accessed on 5 June 2009, http://www.afro.who.int/cdp/documents/steps_tools/summary_final.pdf.

        • Denney-Wilson E.
        • Hardy L.L.
        • Dobbins T.
        • Okely A.D.
        • Baur L.A.
        Body mass index, waist circumference and chronic disease risk factors in Australian adolescents.
        Arch. Pediatr. Adolesc. Med. 2008; 162: 566-573
        • Hales C.N.
        • Barker D.J.P.
        Type 2 (non-insulin dependent) diabetes mellitus: the thrifty phenotype hypothesis.
        Diabetologia. 1992; 35: 595-601
        • Fernandez-Twinn D.S.
        • Ozanne S.E.
        Mechanisms by which poor early growth programs type-2 diabetes, obesity and the metabolic syndrome.
        Physiol. Behav. 2006; 88: 234-243
        • Yajnik C.S.
        • Deshpande S.S.
        • Jackson A.A.
        • Refsum H.
        • Rao S.
        • Fisher D.J.
        • et al.
        Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: the Pune Maternal Nutrition Study.
        Diabetologia. 2008; 51: 29-38
        • Seematter G.
        • Binnert C.
        • Tappy L.
        Stress and metabolism.
        Metab. Syndr. Relat. Disord. 2005; 3: 8-13
        • Sandman C.A.
        • Wadhwa P.
        • Glynn L.
        • Chicz-Demet A.
        • Porto M.
        • Garite T.J.
        Corticotrophin-releasing hormone and fetal responses in human pregnancy.
        Ann. N. Y. Acad. Sci. 1999; 897: 66-75
        • Sandman C.A.
        • Wadhwa P.D.
        • Demet-Chicz A.
        • Dunkel-Schetter C.
        • Porto M.
        Maternal stress, HPA activity, and fetal/infant outcome.
        Ann. N. Y. Acad. Sci. 1997; 814: 266-275
      5. World Health Organization, Promoting optimal fetal development, Report of a Technical Consultation, 2006. Last accessed 8 December 2008, Available at http://www.searo.who.int/LinkFiles/Making_Pregnancy_Safer_Optimalfetal_dev.pdf.

        • Malcolm J.C.
        • Lawson M.L.
        • Gaboury I.
        • Lough G.
        • Keely E.
        Glucose tolerance of offspring of mother with gestational diabetes mellitus in a low-risk population.
        Diabet. Med. 2006; 23: 565-570
        • Yajnik C.S.
        • Fall C.H.D.
        • Coyaji K.J.
        • Hirve S.S.
        • Rao S.
        • Barker D.J.P.
        • et al.
        Neonatal anthropometry: the thin-fat Indian baby. The Pune Maternal Nutrition Study.
        Int. J. Obes. Relat. Metab. Disord. 2003; 27: 173-180
      6. World Health Organisation. Global strategy for infant and young children feeding 2003. Last accessed 12 November 2009. Available at http://www.who.int/nutrition/publications/gs_infant feeding_text_eng.pdf.

        • You S.
        • Götz F.
        • Rohde W.
        • Dörner G.
        Early postnatal overfeeding and diabetes susceptibility.
        Exp. Clin. Endocrinol. 1990; 96: 301-306
        • Bergmann R.L.
        • Bergmann K.E.
        • Dudenhausen J.W.
        Undernutrition and growth restriction in pregnancy.
        Nestle Nutr. Workshop Ser. Pediatr. Program. 2008; 61: 103-121
        • Canadian Paediatric Society
        Growth assessment in aboriginal children: is there need for change?.
        Paediatr. Child Health. 2004; 9: 477-479
        • American Academy of Pediatrics Policy Statement, Committee on Nutrition, Prevention of Pediatric Overweight and Obesity
        Organizational principles to guide and define the child health care system and/or improve the health of all children.
        Pediatrics. 2003; 112: 424-430
      7. World Health Organisation Child Growth Standards: Growth velocity based on weight, length and head circumference Methods and developmenet 2009. Last accessed 12 November 2009. Available at http://www.who.int/childgrowth/standards/velocity/tr3_velocity_report.pdf.

        • American Academy of Pediatrics Committee on School Health
        Soft drinks in schools.
        Pediatrics. 2004; 113: 152-154
        • Barnett T.A.
        • Gauvin L.
        • Craig C.L.
        • Katzmarzyk P.T.
        Distinct trajectories of leisure time physical activity and predictors of trajectory class membership: a 22 year cohort study.
        Int. J. Behav. Nutr. Phys. 2008; 5: 57
        • Dobbins M.
        • De Corby K.
        • Robeson P.
        • Husson H.
        • Tirilis D.
        School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6–18.
        Cochrane Database Syst. Rev. 2009; 21: CD007651
        • Koch F.S.
        • Sepa A.
        • Ludvigsson
        Psychological stress and obesity.
        J. Pediatr. 2008; 153: 839-933
        • Flynn M.A.
        • McNeil D.A.
        • Maloff B.
        • Mutasingwa D.
        • Wu M.
        • For C.
        • et al.
        Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations.
        Obes. Rev. 2006; 7: 7-66
        • Hagura R.
        Diabetes mellitus and life-style for the primary prevention of diabetes mellitus: the role of diet.
        Br. J. Nutr. 2000; 84: S191-S194
        • Hamman R.F.
        • Wing R.R.
        • Edelstein S.L.
        • Lachin J.M.
        • Bray G.A.
        • Delahanty L.
        • et al.
        Effect of weight loss with lifestyle intervention on risk of diabetes.
        Diabetes Care. 2006; 29: 2102-2107
        • Tuomilehto J.
        • Lindstrom J.
        • Eriksson J.
        • Valle T.
        • Hamalainen H.
        Prevention of Type 2 Diabetes Mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N. Engl. J. Med. 2001; 344: 1343-1350
        • Pan X.
        • Li G.
        • Hu Y.
        • Wang J.
        • Yang W.
        • An Z.
        Effects of diet and exercise in preventing NIDMM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.
        Diabetes Care. 1997; 20: 537-544
        • Ceriello A.
        • Motz E.
        Is oxidative stress the pathogenic mechanism underlying insulin resistance, diabetes, and cardiovascular disease? The common soil hypothesis revisited.
        Arterioscler. Thromb. Vasc. Biol. 2004; 24: 816
        • Somannavar S.
        • Lanthorn H.
        • Pradeepa R.
        • Narayanan V.
        • Rema M.
        • Mohan V.
        Prevention awareness counselling and evaluation (PACE) diabetes project: a mega multi-pronged program for diabetes awareness and prevention in South India (PACE-5).
        J. Assoc. Phys. India. 2008; 56: 429-435
        • Holman R.R.
        • Paul S.K.
        • Bethel A.
        • Matthews D.R.
        • Neil H.A.W.
        10-year follow-up of intensive glucose control in type 2 diabetes.
        N. Engl. J. Med. 2008; 359: 1577-1589
        • Gæde P.
        • Vedel P.
        • Larsen N.
        • Jensen G.V.H.
        • Parving H.-H.
        • Pedersen O.
        Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.
        N. Engl. J. Med. 2003; 348: 383-393
        • Viswanathan V.
        • Madhavan S.
        • Rajesekhar S.
        • Chamukuttan S.
        • Ambady R.
        Amputation prevention initiative in South India—positive impact of foot care education.
        Diabetes Care. 2005; 28: 1019-1021
        • Williams R.
        • Gaal L.V.
        • Lucioni C.
        Assessing the impact of complications on the costs of Type II diabetes.
        Diabetologia. 2002; 45: S13-S17
        • Deedwania P.C.
        • Fonseca V.A.
        Diabetes, prediabetes and cardiovascular risk: shifting the paradigm.
        Am. J. Med. 2005; 11: 939-947
      8. IDF Global Treatment guidelines, 2005. Accessed on March 4, 2009, http://www.idf.org/webdata/docs/IDF%20GGT2D.pdf.

        • McGill M.
        • Felton A.M.
        New global recommendations: a multidisciplinary approach to improving outcomes in diabetes.
        Prim. Care Diabetes. 2007; 1: 49-55
        • Renders C.M.
        • Valk G.D.
        • Griffin S.J.
        • Wagner E.H.
        • Eijk van J.ThM.
        • Assendelft W.J.J.
        Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review.
        Diabetes Care. 2001; 24: 1821-1833
      9. World Health Organisation Medicine Strategy: Countries at the core 2004–2007. Last accessed on 12 November 2009. Available at http://whqlibdoc.who.int/hq/2004/WHO_EDM_2004.5.pdf.