The global epidemic of Type 2 diabetes is an indicator of serious underlying issues in our society, says a University of Sydney medical expert.
"People think of this as an issue of individual responsibility - you're overweight, you've got diabetes, it's your fault. But it just isn't," said Associate Professor Bruce Neal.
"You are overweight because you live in a society that make it easy for you to be overweight, that bombards you with advertising about the wrong kinds of foods, that doesn't make it easy for you to lose weight," said Professor Neal.
More than 250 million people worldwide have Type 2 diabetes, and the numbers are growing rapidly. Most will eventually die or be disabled by the complications.
"Diabetes is an indicator of serious underlying issues in our society," he added. "We have to get governments much more engaged in addressing the reasons why we have this epidemic. Unless they take a more active role it is not going to go away. It is not going to get better. In fact it is going to get much worse."
Professor Neal was speaking after the release of a landmark study, the biggest of its kind ever conducted, that shows that a combination of two blood pressure lowering drugs reduces the risk of death in Type 2 diabetes patients, as well as their risks of heart and kidney disease.
The ADVANCE (Action in Diabetes and Vascular Disease) Study was led by researchers at The George Institute for International Health. The Institute is affiliated to Sydney University with a mission to seek solutions for major global public health problems through research, policy development and training.
"The really novel thing about this study was that we lowered blood pressure, irrespective of what your blood pressure was to start with," said Professor Neal. "So if you had Type 2 diabetes, we lowered your blood pressure whether you had hypertension or not.
"We showed very clearly that you reduce the overall risks of serious complications of diabetes - heart attack, stroke, eye disease, kidney disease. We reduced your risk of dying and in particular we reduced your risk of dying from a heart attack."
The global study followed 11,140 people for four and a half years. They were recruited from more 200 centres in 20 countries around the world.
"We used a lot of different countries to ensure that we could generalise the result to as many people as possible," said Professor Neal. "If you just did the study in Australia, then it would be quite hard to persuade Chinese clinicians that this result is relevant to them - or Indian clinicians, or even North American clinicians for that matter."
The study showed that the treatment worked for a Chinese lifestyle, a western lifestyle, or an Indian lifestyle.
"Type 2 diabetes is a massive problem around the world, and on average, someone with diabetes lives 5 to 10 years less than someone who doesn't have Type 2 diabetes. It causes a huge economic burden, and in particular the complications that we were preventing in this study are a major cost to the health system.
"This trial is a great step forward."