What do we mean when we talk about life course? Definition and epidemiology

Abstract

The Pact aims to reduce the risk of diabetes mellitus (DM) and ensure that all people diagnosed with DM have access to equitable, comprehensive, affordable, and quality treatment and care. The Pact's work also supports the prevention of type 2 diabetes (T2D) by addressing obesity, unhealthy diets, and sedentary lifestyles.

The Pact works to achieve five global diabetes coverage targets by 2030: 1) 80% of people with DM are diagnosed; 2) 80% of people diagnosed with DM have good glycemic control; 3) 80% of people diagnosed with DM have good blood pressure control; 4) 60% of people with DM aged 40 and over receive statins; 5) 100% of people with type 1 diabetes have access to affordable insulin and self-monitoring of blood glucose.

These objectives constitute a fundamental part of the work requested by Member States through resolution WHA74.4, adopted at the 74th World Health Assembly in 2021. This new perspective on life-course care represents a shift from the traditional model of care to the current model, integrating the different stages of life as a metabolic continuum.

The global goal for NCDs is to halt the rise in diabetes mellitus (DM) and obesity, and no country in the Americas region is on track to achieve this goal. The prevalence of diabetes and obesity is increasing in all countries. In a 2022 study in our country of more than one million pregnant women, the average body mass index was above 25 kg/m2, indicating a prevalence of 24.4% and 14.7% of overweight and obesity, respectively. This will negatively impact the prevalence of gestational DM.

This will be exacerbated by the rising prevalence of obesity in children and adolescents, which increased by 44.6% from 2000 to 2022.

In 2023, Argentina recorded a maternal mortality ratio of 3.2 per 100,000 live births, representing an increase compared to previous years. The main causes of maternal death included heart disease, tumors, and cerebrovascular disease. To address these problems, we must shift from a fragmented approach to healthcare to an integrated view of the different stages of life as a metabolic continuum.

The life course approach is understood as the way in which experiences and conditions throughout life affect future health. These influences can be positive or negative, and they shape how we live and develop in society.

This life course begins before pregnancy, with a genetic predisposition and impacting risk factors for diabetes mellitus (DM) such as maternal age, obesity, and unhealthy habits. During pregnancy, the diagnosis of hyperglycemia between the second and third trimesters, followed by a postpartum period marked by persistent insulin resistance, chronic subclinical inflammation, dyslipidemia, endothelial dysfunction, and vascular damage, can progress to type 2 diabetes, atherosclerosis, and cardiovascular disease. This path, which began in the womb, is a shared responsibility to change this risk trajectory through cost-effective measures.

The traditional model is a classic risk model that focuses strictly on adulthood, measuring specific factors such as weight, smoking habits, and dietary patterns. It conceptualizes type 2 diabetes as a pathophysiological event disconnected from prior life experiences.

This aligns with the Origin of Developmental Hyperglycemia (DoHaD) theory, specifically Baker's hypothesis, which posits that intrauterine growth restriction (IUGR) and nutritional overexposure (gestational diabetes) force the fetus to undergo compensatory adaptive processes. These adaptations permanently reduce pancreatic beta cell mass and program peripheral insulin resistance that will persist throughout life.