Primary care is ‘fundamental’ to tackling global burden of diabetes, researchers stress

Researchers from the University of Leicester and the NIHR ARC East Midlands are among the authors of a review which examines the role of primary care on global diabetes management.

Latest figures estimate that 589 million adults aged 20–79 are living with diabetes – around 11.1% of the global population – and cases are increasing at speed, with low- and middle-income countries faring the worst in terms of rising numbers and unmet need. 

The new review, published in The Lancet Diabetes & Endocrinology, highlights how many health systems across the world face persistent gaps in diagnosis, treatment and follow-up of people with diabetes. 

Primary care, the authors say, is the most accessible platform for screening and care coordination and is “central to addressing these challenges”. 

They highlight how primary care-led models including nurse and pharmacist-led interventions, integrated multidisciplinary teams, and digitally enabled care have shown improvements in glycaemic control and cardiometabolic outcomes. 

The review identifies the barriers to implementing primary care-led diabetes management including workforce capacity and variation in training and reiterates how disparities in outcomes by ethnicity are seen even in enhanced primary care models, which highlights the need for culturally tailored approaches.

The authors conclude that future research in primary care for diabetes must move beyond isolated innovations towards system-wide transformation, saying: “By integrating implementation science, equity, responsible digital innovation, workforce reform, and policy evaluation, research can support primary care models that are effective, equitable, and sustainable across diverse global contexts.” 

The review was presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Milan on October 1, with simultaneous publication in The Lancet Diabetes & Endocrinology. 

Professor Kamlesh Khunti, Co-Director of the NIHR ARC East Midlands, Co-Theme Lead at the NIHR Biomedical Research Centre Leicester, Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester and senior author of the paper, said: “Strengthening primary care is fundamental to addressing the rising global burden of diabetes and endocrine disorders.”

“As the first point of contact for most people, primary care offers scalable and cost-effective opportunities for routine and opportunistic screening, early treatment, and long-term follow-up. 

“As populations age and the proportion of people living with multiple long-term conditions increases, primary care must evolve from episodic, reactive care to integrated, proactive, and accountable models.”

Dr Harini Sathanapally, Doctoral Fellow on the Wellcome LHIIP programme at the University of Leicester, General Practitioner and joint first author, said: “A key challenge is implementing equitable models that can be adapted to population needs across different health-system contexts.”

Dr Partha Kar, Type 1 Diabetes & Technology Lead for NHS England, co-lead of Getting it Right First Time (Diabetes), Visiting Professor at the University of Leicester, Consultant in Diabetes & Endocrinology at Portsmouth Hospitals NHS Trust, and joint first author, said: “If we want to improve diabetes care at scale, the key sits with primary care – and this overview gives an idea of the challenges in trying to ensure primary care has the support needed. At a policy level, this is where the focus needs to be.” 

To read the full paper, click here.