South bearing the brunt of global diabetes burden
The majority of those with diabetes is in the
South-East Asia and Western Pacific Regions, accounting for
approximately half the diabetes cases in the world.
By Kanaga Raja
The number of people living with diabetes has almost quadrupled from
108 million in 1980 to an estimated 422 million adults in 2014, and its
prevalence is rising faster in low- and middle-income countries than in
high-income countries over the past decade, the World Health
Organisation (WHO) has said.
In its first global report on diabetes released in April, WHO said
that diabetes caused 1.5 million deaths in 2012, with
higher-than-optimal blood glucose causing an additional 2.2 million
deaths, by increasing the risks of cardiovascular and other diseases.
Forty-three percent of these 3.7 million deaths occur before the age
of 70 years, and the percentage of deaths attributable to high blood
glucose or diabetes that occurs prior to age 70 is higher in low- and
middle-income countries than in high-income countries.
The largest numbers of people with diabetes were estimated for the
WHO South-East Asia and Western Pacific Regions, accounting for
approximately half the diabetes cases in the world.
The WHO Eastern Mediterranean Region has experienced the greatest
rise in diabetes prevalence, and is now the WHO region with the highest
prevalence (13.7%).
According to the specialised United Nations agency, diabetes is a
serious, chronic disease that occurs either when the pancreas does not
produce enough insulin (a hormone that regulates blood sugar, or
glucose), or when the body cannot effectively use the insulin it
produces.
The majority of people with diabetes are affected by type 2 diabetes
(where the body cannot properly use the insulin it produces). According
to WHO, Type 1 diabetes requires insulin injections for survival.
In a preface to the report, WHO Director-General Dr Margaret Chan,
said: “Diabetes is on the rise. No longer a disease of predominantly
rich nations, the prevalence of diabetes is steadily increasing
everywhere, most markedly in the world’s middle-income countries.”
Unfortunately, she said, in many settings the lack of effective
policies to create supportive environments for healthy lifestyles and
the lack of access to quality health care means that the prevention and
treatment of diabetes, particularly for people of modest means, are not
being pursued.
“Around one hundred years after the insulin hormone was discovered,
the global report on diabetes shows that essential diabetes medicines
and technologies, including insulin, needed for treatment are generally
available in only one in three of the world’s poorest countries,” said
Dr Etienne Krug, Director of the WHO’s Department for the Management of
Non-Communicable Diseases (NCDs), Disability, Violence and Injury
Prevention.
“Access to insulin is a matter of life or death for many people with
diabetes. Improving access to insulin and NCD medicines in general
should be a priority,” Dr Krug said, in a WHO press release.
According to the WHO report, diabetes of all types can lead to
complications in many parts of the body and can increase the overall
risk of premature death.
“Possible complications include heart attack, stroke, kidney failure,
leg amputation, vision loss and nerve damage. In pregnancy, poorly
controlled diabetes increases the risk of fetal death and other
complications.”
The lack of access to affordable insulin remains a key impediment to
successful treatment and results in needless complications and premature
deaths, said the report.
Insulin and oral hypo-glycaemic agents are reported as generally
available in only a minority of low-income countries.
The report said that only 23% of low-income countries (six countries)
report that insulin is generally available, in contrast to 96% of
high-income countries (54 countries).
“Moreover, essential medicines critical to gaining control of
diabetes, such as agents to lower blood pressure and lipid levels, are
frequently unavailable in low- and middle-income countries. Policy and
program interventions are needed to improve equitable access.”
WHO said the risk of type 2 diabetes is determined by an interplay of
genetic and metabolic factors.
“Ethnicity, family history of diabetes, and previous gestational
diabetes combine with older age, overweight and obesity, unhealthy diet,
physical inactivity and smoking to increase risk.”
Excess body fat, a summary measure of several aspects of diet and
physical activity, is the strongest risk factor for type 2 diabetes,
both in terms of clearest evidence base and largest relative risk.
Overweight and obesity, together with physical inactivity, are
estimated to cause a large proportion of the global diabetes burden.
High intake of sugar-sweetened beverages, which contain considerable
amounts of free sugars, increases the likelihood of being overweight or
obese, particularly among children. “Recent evidence further suggests an
association between high consumption of sugar-sweetened beverages and
increased risk of type 2 diabetes,” said the report.
Diabetes imposes a large economic burden on the global health-care
system and the wider global economy.
This burden can be measured through direct medical costs, indirect
costs associated with productivity loss, premature mortality and the
negative impact of diabetes on nations’ gross domestic product (GDP).
According to the report, based on cost estimates from a recent
systematic review, it has been estimated that the direct annual cost of
diabetes to the world is more than US$827 billion. The International
Diabetes Federation (IDF) estimates that total global health-care
spending on diabetes more than tripled over the period 2003 to 2013 -
the result of increases in the number of people with diabetes and
increases in per capita diabetes spending.
WHO said while the major diabetes cost drivers are hospital inpatient
and outpatient care, “a contributing factor to this increase is the rise
in expenditure on patented, branded medicines used to treat people with
diabetes, including both new oral treatments for type 2 diabetes.”
“The increase in total global diabetes health expenditure is expected
to continue. Low- and middle-income countries will carry a larger
proportion of this future global health-care expenditure burden than
high-income countries.”
– Third World Network Features.
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