The contribution of unrecognized factors to the diabetes epidemic

The considerable global prevalence of dysglycemia has primarily been attributed to external factors such as globalization, poor nutrition including consumption of energy-rich foods, sedentary lifestyle and the pervasive influence of the food industry leading to overconsumption and weight gain. Indeed, these factors have generated particular concern in emerging countries which anticipate an enormous incremental burden in diabetes over the next decades and yet are unable to afford the considerable economic impact associated with increased rates of obesity and dysglycemia and their associated complications. While the aforementioned considerations are well-established, unrecognized factors may inadvertently and insidiously be contributing to the diabetes epidemic, including (a) detection of glucose disorders late in the lengthy trajectory to the development of diabetes, which is related to (b) non-physiologic parameters in defining glucose disorders, (c) discrepant criteria for diagnosing dysglycemia, (d) inadequate referral of high-risk individuals for lifestyle counselling and (e) suboptimal training and education of medical and ancillary healthcare professionals in prevention.