It’s a potentially fatal disease whose risks can in many cases be prevented through lifestyle measures. So why has diabetes seen a massive increase in sufferers?
The number of people living with the potentially fatal disease has quadrupled since 1980, to more than 400 million, according to the World Health Organization (WHO).
Worldwide, diabetes killed 1.5 million in 2012 alone, with high blood-glucose causing another 2.2 million deaths, the organization says.
In its first Global Diabetes Report, the WHO says a “whole-of-government and whole-of-society approach” is required to tackle the disease, which costs an estimated $827 billion annually in patient care and medicine.
The WHO report, published in the medical journal Lancet, also highlights inequalities between countries, as diagnoses and medicine are more accessible in high-income nations.
What is diabetes?
Diabetes is a chronic disease caused by the body’s failure to produce enough insulin to regulate blood glucose — or blood sugar.
Raised blood glucose can eventually damage the heart, blood vessels, eyes, kidneys and nerves. Abnormally low blood glucose can cause seizures and loss of consciousness.
Type 1 diabetes is not currently preventable and sufferers require daily administration of insulin to survive.
Type 2 diabetes — which results from the body’s ineffective use of insulin — is far more common and can be influenced by lifestyle as well as genetic and metabolic factors.
Impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG) are elevated glucose levels not yet at the level of diabetes but which nonetheless increase the risk of heart attacks and strokes.
Additionally, pregnant woman can develop gestational diabetes, increasing the risk of complications and the long-term risk of type 2 diabetes.
Why is diabetes on the rise?
The WHO says that between 1980 and 2014, the percentage of adults with diabetes increased from 4.7% of the global population to 8.5% (from 108 million to 422 million).The rise, it says, mirrors “the global increase in the number of people who are overweight or obese.”
Among the WHO’s key findings about exercise and :
• In 2010 nearly a quarter of adults (18 and older) were classified as “insufficiently physically active.”
• Even more alarming were the figures on inactivity among adolescents, with 84% of female adolescents and 78% of males falling short.
• In 2014, almost one in four adults aged over 18 years was overweight and more than one in 10 were obese.
Which countries are most affected?
“Prevalence is growing most rapidly in low- and middle-income countries,” the report says.
The biggest estimated percentage rises were in the Western Pacific, African, Southeast Asia and Eastern Mediterranean regions — with the last having an increase from 5.9% to 13.7% of the population.
Adult mortality rates from high blood-glucose increased globally over the same period, with the African, Eastern Mediterranean and Southeast Asia regions worst affected.
What can be done?
“Some risk factors for type 2 diabetes — such as genetics, ethnicity and age — are not modifiable,” the WHO says, but others, such as weight, diet, exercise and smoking, are.
“At the individual level, intensive interventions to improve diet and physical activity can prevent or delay the onset of type 2 diabetes in people at high risk.”
It says all government sectors must “systematically consider the health impact of policies in trade, agriculture, finance, transport, education and urban planning — recognizing that health is enhanced or obstructed as a result of policies in these and other areas.”
The WHO suggests, for example, that urban planning could encourage physical activity by ensuring nonmotorized transport is accessible and safe, while taxation — as in the case of Mexico — could be enacted to try to reduce demand for sugary beverages.
Early diagnosis in primary health care settings is also key to avoiding poor health outcomes, the WHO says and must be easily accessible.
What about medicine to treat diabetes?
Just as basic technologies for diagnosis and monitoring of diabetes in low-income and lower middle-income countries are less accessible, so too is insulin, the WHO says.
Limited competition between a small number of multinational manufacturers can increase prices, with low-income countries generally paying the most for the treatment, it says.
“Governments’ decisions about insulin purchasing– tendering practices, choice of supplier, choice of products and delivery devices — can have a huge impact on budgets and on costs to end users.
“Governments may recoup high costs by charging mark-ups to patients. In Mozambique, for example, insulin purchased from local wholesalers was 25% to 125% more expensive than that purchased through international tenders,” the WHO says.
It says while insulin is reported as available in 72% of countries it varied widely by region and country.
“Only 23% of low-income countries (six countries) report that insulin is generally available, in contrast to 96% of high-income countries (54 countries).
“Further, the reported general availability of insulin in the WHO Region of the Americas and the European Region is more than double that of the WHO African Region and South-East Asia Region,” the report says.
Any silver lining?
The WHO says the results of its 2015 Noncommunicable Disease Country Capacity Survey give an “encouraging global impression” that countries are addressing diabetes.
“Nearly three-quarters (72%) of countries have a national diabetes policy that is implemented with dedicated funding, and countries are also taking action at the policy level to address unhealthy diets and physical inactivity,” it says.
But the WHO warns that policy needs to be translated into action, with less than half of countries with national guidelines or standards on diabetes actually implementing them.
A co-ordinated approach is needed.
“Everyone has a role to play — governments, health-care providers, people with diabetes and those who care for them, civil society, food producers, and manufacturers and suppliers of medicines and technology are all stakeholders,” the WHO says.
“Collectively, they can all make a significant contribution to halt the rise in diabetes and improve the lives of those living with the disease.”