[The coming diabetes tsunami: the Netherlands should exploit its lead]

Abstract

Some authors claimed that if current trends prevail, 1.32 million people will have been diagnosed with diabetes mellitus in the Netherlands by 2025. In this commentary, the author sheds doubt on some of the underlying assumptions. First, the author argues that advanced age in itself cannot be an immutable cause of diabetes since there must be underlying mechanisms, which may be modifiable. Second, improved early detection of diabetes, which is a cause for a higher prevalence, also creates possibilities for action. Finally, the author does not believe that the current rates of overweight will be sustained over the next 16 years through to 2025. The author also discusses the debate surrounding the use of the Diabetes Prevention Program in the U.S. and the application of the Archimedes mathematical model to calculate cost-effectiveness of rapid adoption of the Diabetes Prevention Program versus delayed adoption or drug treatment with metformin, as well as the heated debate with the Markov modellers of the Diabetes Prevention Program research group about model details and validations.