Diabetes Outgrew the Specialist. Nurses and Pharmacists Step In

Key Takeaway: Type 2 diabetes is spreading too quickly, especially in low- and middle-income countries, for hospital specialists to handle alone. A new review in The Lancet Diabetes & Endocrinology suggests that care led by nurses and pharmacists in the community improves blood sugar control, reduces complications, and prevents avoidable hospital admissions. Shifting routine diabetes care to these teams, supported by national digital tracking systems, may be the only realistic way to meet global targets.

The Waiting Room That Never Empties

Picture a 52-year-old market vendor in a growing city. At a free screening day, she learns that her HbA1c, a blood test that reflects average blood sugar over the past three months, is above 9 percent. That level puts her at serious risk of blindness, kidney failure, and heart attack. She is referred to the only endocrinologist in the district. The next available appointment is five months away, two bus rides from home, and costs a day’s wages. She doesn’t go. Three years later she arrives in the emergency department with a foot infection that has reached the bone.

Her story is not unusual. It plays out millions of times a year, and the arithmetic explains why. According to the International Diabetes Federation, about 537 million adults were living with diabetes in 2021, a number projected to reach roughly 783 million by 2045, and around three in four of them live in low- and middle-income countries^[2]. In much of the world, there are not enough diabetes specialists to see even a small share of these patients. The disease has outgrown the model we built to treat it.

What the Researchers Did

This is a narrative review published in The Lancet Diabetes & Endocrinology. It brings together existing evidence on how diabetes care is delivered across different health systems. It is not a single clinical trial, and the summary available to us does not report a combined patient count. Its goal was to ask a policy question: what kind of care structure can actually scale to match the size of the epidemic?

What They Found

The central finding is direct. Decentralized primary care models, in which nurses and pharmacists lead…