Diabetes Epidemic Of The 21st Century
On December 20th 2006, the United Nations General Assembly passed Resolution 61/225. This landmark Resolution “recognizes diabetes as a chronic, debilitating and costly disease………….that poses severe threats for the entire world.”
The Resolution proposed by the United Nations on diabetes was necessary because it is fast emerging as, probably, the most serious health problem of our time. If the awareness of the threat that diabetes poses for future generations remains pitifully low, then diabetes has the potential to be a global epidemic which will have devastating human, social and economic consequences. The following will outline recent statistics from the W.H.O., International Diabetes Federation and the United Nations, to show how far diabetes has progressed on the road to epidemic status.
Diabetes is a chronic disorder that is normally characterised by high blood glucose and either insufficient or ineffective insulin- depending on the type of diabetes. In simple terms, diabetes is a medical condition that affects the body’s ability to take energy from foodstuffs and use that energy as fuel. According to the Penguin English Dictionary (2002), an epidemic is “an outbreak of a disease affecting many individuals within a population or region at the same time.”
Looking at the shape of things
Type 1 Diabetes: Insulin dependent diabetes mellitus(IDDM)- this type is the least common of the two types of diabetes, affecting only about 2.5% of sufferer’s. It usually appears in children or young adults. The problem that is central in type 1 diabetes is that the pancreas cannot produce insulin and therefore the body cannot take energy from the food that is consumed.
Type 2 Diabetes: This is the predominant form of diabetes and it most often develops in people over 40 years of age. However, it is becoming more and more prevalent in obese children and teenagers. This type of diabetes usually develops when the body produces some insulin but not enough for the body’s needs or if the insulin produced is not properly used by the body. This type of diabetes is easier to control and treat.
Symptoms: The onset of type 1 diabetes is often sudden and dramatic and can include symptoms such as:
• Abnormal thirst/dry mouth
• Frequent urination
• Extreme tiredness/lack of energy
• Constant hunger
• Sudden weight loss
• Recurrent infections
• Blurred vision
The same symptoms that are listed above can also affect people with type 2 diabetes, but usually the symptoms are less obvious and the onset is gradual and often hard to detect. Problems with this arise when the people are diagnosed several years later but already have other diabetic complications present.
Life-threatening complications which can result from diabetes include:
• Diabetic nephropathy- kidney disease which can lead to complete kidney failure.
• Diabetic retinopathy- eye disease that damages the retina of the eye which could lead to vision loss.
• Diabetic neuropathy- nerve disease which could lead to amputation of the feet and lower limbs.
• Cardiovascular disease which can cause coronary heart disease and stroke.
Treatment: “The major goal in treating diabetes is to minimize any elevation of blood sugar (glucose) without causing abnormally low levels of blood sugar.”
The treatments for type 1 diabetes are:
• Diabetic diet
The treatments for type 2 diabetes are:
• Weight reduction
• Diabetic diet
• Exercise- however, if these measures fail to control the elevated blood sugars, oral medications can be used. If oral medications are still insufficient, insulin treatments will be considered.
Obesity: “An excessive accumulation of body fat…………..which is sufficient to impair health.” W.H.O. Obesity Report (2005)
B.M.I.(Body Mass Index): This is the current method being used by the W.H.O. to measure excess body fat. The person’s weight (in kg’s) is divided by the square of their height (in metres).
• BMI 25> is considered to be overweight
• BMI 30> is considered to be clinically obese.
What is “DIABESITY”?
The twin burden of diabetes and obesity- now more commonly known as diabesity – is a major contributor to the prevalence of diabetes in modern western society. Obesity in Europe has just about reached epidemic proportions. Its frequency in western society has tripled in the last two decades, and if no action is taken there will be an estimated 150 million obese adults and 15 million obese children and adolescents in the European region of the W.H.O. by the year 2010.
These figures are the equivalent of 20% and 10% of the population respectively and are showing an upward trend even in countries with traditionally low rates of obesity like France, Holland and Norway. In addition, the gap which used to exist between Western and Eastern Europe is also closing rapidly. Although significant differences exist – between and within countries; social groups; men and women and age groups – all recent evidence is that obesity rates are rising within all parts of the region.
However, a major misconception regarding diabetes is that it only affects rich, industrialised countries: e.g. USA, Europe, Australia- wrong……..
Diabetes hits all populations regardless of income/ status/race. One crucial factor to remember is that the poor and children have limited choices when it comes to living conditions, diet and education. In many countries in Asia, the Middle East, Oceania and the Caribbean, diabetes affects 12-20% of the population. In addition, statistical projections point to the fact that in 2025, 80% of all cases of diabetes will be in low and middle- income countries.
Further evidence from the International Diabetes Federation shows that in many developing countries, the economic burden of diabetes care threatens to undermine the benefits of improving standards of living, education and economic growth. Almost 80% of the current 246 million people with diabetes live in developing countries yet 80% of the global expenditure on medical care for diabetes is made between the worlds economically richest countries. This means that not enough is being spent in the developing countries to even provide the least expensive lifesaving diabetes drugs.
Many governments tax insulin at their borders and therefore prevent low-cost basic insulin from being sold. A recent comparison of three otherwise similar African countries showed the consequences:
1. Zambia- has a programme for insulin management. A person requiring insulin for survival can expect to live an average of 11 years.
2. Mali- the same person can expect to live for only 30 months.
3. Mozambique- same person would be dead within a year.
Changes to the living environment, early detection and the adoption of proven measures to prevent diabetes could significantly lower the risk of developing type 2 diabetes, delay its onset or at least reduce its impact. For people with type 1 diabetes it is not yet possible to prevent the disease. However, much can be done to prevent or delay the associated complications if people had access to adequate care, medication and monitoring equipment
The current mission of the International Diabetes Federation revolves around three main factors:
1. Care: The promotion of the best possible care for anyone who has to live with diabetes and to increase access to and the quality of the care that is currently available.
2. Prevention: Primary prevention is needed to curb the rise in diabetes diagnosis’ and to lessen the impact diabetes currently has on those living with the disease.
3. Cure: The International Diabetes Federation encourages, through awareness and education, those who seek to further understand the causes of diabetes.
The Way Forward
In the western world, obesity and physical activity are the most preventable risk factors in the fight against diabetes, and by controlling weight-gains and increasing physical activity, the rate of new diabetes diagnosis could be significantly reduced.
When it comes to the developing world, governments need to be pro-active to halt the spread of diabetes. A three pronged attack is required:
1. Structural programmes geared towards prevention.
2. Commitment of more resources towards research and medical care- these costs need to be considered as an investment.
3. More education- especially the socially deprived.
The problem of this oncoming epidemic cannot be placed at the feet of individuals alone- this action is not appropriate or acceptable. This problem is social and economic and government response is a necessity. Tackling diabetes is likely to be one of the most important challenges for the global health community in the 21st century.
According to the International Diabetes Federation president Mr. Martin Silink, “The diabetes time bomb has been ticking for 50 years, and it’s been getting louder. Despite the warning, successive generations of world leaders have largely ignored the threat. Diabetes has now exploded with the force felt greatest in the Middle East, India, China and the USA.”
World Diabetes Day, November 14th 2007