Correspondence

IDF now maintains a database of all aged 25 years and older estimated by
studies reporting diabetes prevalence,
both published and unpublished. Each
study is scored for quality against
several criteria, such as age of the
study, representativeness, method
of identifying diabetes, and so on.
The scores that are given against
each criterion were determined
independently by an international
expert committee using the analytic
hierarchy process.4 Low-quality
studies are not used. Where possible
the prevalence estimates for a country
are based on one or more high-
quality studies done in that country.
If there is no high-quality study for
a given country, which was the case
for almost half of the 215 countries
and territories included, results from
a “data region” are used as a proxy. A
data region represents countries in
the same geographical area, of the
same economic status (on the basis
of the World Bank classification), and
the same predominant ethnic group.4
The whole approach is transparent,
manipulation, or suturing. Why, as
the GBMRF for 2008.
We declare that we have no conflicts of interest.
*Nigel Unwin, Leonor Guariguata,
David Whiting, Clara Weil
nigel.unwin@cavehill.uwi.edu
Faculty of Medical Sciences, Cave Hill Campus,
University of the West Indies, BB1100 Barbados
(NU); and International Diabetes Federation,
Brussels, Belgium (LG, DW, CW)
1 Danaei G, Finucane MM, Lu Y, et al. National,
regional, and global trends in fasting plasma
glucose and diabetes prevalence since 1980:
systematic analysis of health examination
surveys and epidemiological studies with
370 country-years and 2·7 million participants.
Lancet 2011; 378: 31–40.
2 Wild S, Roglic G, Green A, Sicree R, King H.
Global prevalence of diabetes: estimates for
the year 2000 and projections for 2030.
Diabetes Care 2004; 27: 1047–53.
3 Shaw JE, Sicree RA, Zimmet PZ. Global estimates
of the prevalence of diabetes for 2010 and 2030.
Diabetes Res Clin Pract 2010; 87: 4–14.
4 Guariguata L, Whiting D, Weil C, Unwin N. The
International Diabetes Federation diabetes
atlas methodology for estimating global and
national prevalence of diabetes in adults.
Diabetes Res Clin Pract 2011; 94: 322–32.
5 Whiting DR, Guariguata L, Weil C, Shaw J. IDF
diabetes atlas: global estimates of the
prevalence of diabetes for 2011 and 2030.
Diabetes Res Clin Pract 2011; 94: 311–21.
Paul Farmer stated, does surgery
remain the “neglected stepchild of
global health?”2 For us the omission
is striking. If we are to care adequately
for the health of populations
throughout the world, we need to
be inclusive; we need to think of
medicine and surgery—one without
the other is like yin without yang.
We declare that we have no conflicts of interest.
*Adam L Kushner, T Peter Kingham,
Benedict C Nwomeh
adamkushner@yahoo.com
Surgeons OverSeas (SOS), New York, NY 10003,
USA (ALK, TPK, BCN); Department of Surgery,
Columbia University, New York, NY, USA (ALK);
Department of Surgery, Memorial Sloan Kettering
Cancer Center, New York, NY, USA (TPK); and
Department of Pediatric Surgery, Nationwide
Children’s Hospital, Columbus, OH, USA (BCN)
1 Das P, Samarasekera U. The Commission on
Macroeconomics and Health: 10 years on.
Lancet 2011; 378: 1907–08.
2 Farmer PE, Kim JY. Surgery and global health:
a view from beyond the OR. World J Surg 2008;
32: 533–36.

reproducible, and readily amenable to

investigation of the effect of changing
study selection criteria.
A potential advantage of the IDF
over the GBMRF approach is that the
prevalence estimate for each country
is based on one or a small number of
clearly identifiable studies. This could
make it easier to discuss the basis
of the estimates with policy makers
and other stakeholders. A current
weakness of the IDF estimates by
Corbis
Medicine and surgery:
the yin and yang of
health systems
In health care we frequently pair
disorders or terms: flexion and
extension, inhale and exhale, benign
and malignant, and of course male
and female. In the global health

contrast with those from GBMRF is the community we speak of developing

lack of uncertainty intervals, and this is
something that is being addressed.
When roughly only half of all
countries have nationally represent-
ative data, the IDF and GBMRF
provide complementary, cross-
validating approaches to estimation
of the global burden of diabetes.
The total number of adults (aged
20–79 years) globally estimated to
have diabetes by the IDF in 2011 is
366 million,5 consistent with a figure
of 347 million (95% uncertainty
interval 314–382 million) in those
and developed countries, and com-
municable and non-communicable
diseases, and make distinctions
between urban and rural populations.
In light of the tenth anniversary
of the report of WHO’s Commission
on Macroeconomics and Health,1
and with global health interventions Department of Error
moving away from vertical pro- Morin CM, Benca R. Chronic insomnia. Lancet
2012; 379: 1129–41—Copyright in all DSM-5
grammes to focus more on health proposed draft material in panel 4 of this
system strengthening, we are rather Seminar (March 24) is owned by the American
dismayed by the almost absent Psychiatric Association. This correction has
been made to the online version as of
reference to prevention or treatment April 20, 2012.
of disease by incision, excision,

1488 www.thelancet.com Vol 379 April 21, 2012