Diabetes takes an immense toll on those who live with the disease wherever they are, but the diseases is particularly devastating in low-and middle-income countries, which account for 80% of all diabetes-related deaths. That’s nearly 4 million deaths per year, often taking a wage earner from his or her family, and as a result impoverishing whole societies. In these low- and middle-income countries, 288 million people are living with diabetes, and sadly, half of these people have not even been diagnosed. So the challenges to public health are twofold: having the appropriate infrastructure to diagnose as well as managing people living with the disease.

In a country like China, where one finds a quarter of all diabetes cases in the world, the government and its partners are continuously trying to catch-up with this growing and costly epidemic.

In many ways, there exist the tools and the knowledge to meet the disease. In policy, there is the global and national recognition of the threat of diabetes and resulting plans of action, such as the Chinese National Plan for Non-Communicable Disease Prevention and Treatment. Healthy diets and physical exercise are of critical importance to diabetes prevention. With an estimate of 200 million additional people in the world with diabetes by 2035, it is clear we cannot “treat our way” out of the disease. In addition, diabetes treatments have developed rapidly, with better outcomes for people living with the disease.

Where there is a significant gap in quality diabetes care in middle income countries (MICs) is the on-the-ground implementation of programs to reduce the incidences of diabetes—the healthcare infrastructure. A report by Charles River Associates, “Assessing the Value of Treatment for Diabetes to Patients, the Healthcare System, and Wider Society – a Case Study on China”, states that whereas diabetes treatment and management are very well defined in high income countries, access to such treatment is significantly less complete in middle income countries.

Three in 5 people with diabetes in China have poor glucose control, meaning faster progression rates of the disease and its complications, including cardiovascular diseases, blindness, amputation and kidney failure. Appropriate treatment and glycaemic control can delay or prevent the progression of diabetes, thereby reducing the burden upon health systems. Policy and medicines alone cannot bridge to quality diabetes care; there must be appropriate technology, specialists, and adequately trained doctors and nurses at primary care level.

Improved infrastructure means action from the national government, in unilateral initiatives as well as in partnership with other health organizations. Examples include the Go West Training Program in China, a public-private partnership with Bayer Healthcare, and initiatives to improve infrastructure in other MICs, like the Lilly NCD Partnership and the Sanofi Diabetes at School Program, helping teachers better manage their young students with diabetes.

Better infrastructure also includes better data, scaling up only the interventions that work, from national awareness and prevention campaigns, to the impact of a new innovative medicine upon the number of years lost due to ill-health, disability or early death (disability-adjusted life years—DALYs) for one single patient and for the country as a whole.