Killing 5 million a year, diabetes becomes major menace to global health

This was originally published on Global Health TV on November 23, 2015.

Over the last 25 years, diabetes has emerged as a major threat – and growing consumer of precious global health resources – in the developing world. In 1990, according to the Institute for Health Metrics and Evaluation (IHME), it was not even in the top ten leading causes of death globally.  Now it is number nine on the list.

In the seventh edition of its Diabetes Atlas, the International Diabetes Federation (IDF), an umbrella organization of over 240 national diabetes associations, says that diabetes kills almost 5 million people every year and that every six seconds a person dies from diabetes. This compares to those who die each year from AIDS (1.5 million), tuberculosis (1.5 million) and malaria (600,000).

The latest version of the Diabetes Atlas, which will be published on Dec. 1, calls diabetes “one of the largest global health emergencies of the 21^st century.” Currently, 415 million people have it (1 in 11). By 2040, if current trends continue, 642 million will have it (1 in 10).

Like other non-communicable diseases, an estimated three quarters of people with diabetes live in low- and middle-income countries. Often the disease hits people of working age, in their most productive years. In most sub-Saharan African countries 60% or more of adults with diabetes die before the age of 60.

IDF expects to see a sharp increase in diabetes in low- and middle-income countries by 2040, such as South and Central America where it expects an increase of 65%.

World Diabetes Day was marked on the 14^th of November with a focus on healthy eating and the slogan “Halt the diabetes epidemic: Make healthy eating a right, not a privilege.” IDF calls for action to improve access and affordability of healthy food choices to reduce the burden of diabetes and save billions in lost productivity and healthcare costs.

Already, 12% of global health expenditures is being spent on diabetes ($673 billion), according to the IDF.  This year, diabetes will cost somewhere between US $673 and 1,197 billion in healthcare spending.

The costs associated with diabetes include the financial burden placed on individuals and their families due to the cost of insulin and other medicines as well as the increased use of health services, loss of productivity and disability. So diabetes is not only a health issue but a serious obstacle to sustainable economic development.

And here’s one thing that diabetes has in common HIV – many people who have it don’t know they have it. The IDF estimates that 46.5% of adults with diabetes worldwide are undiagnosed. The African region has the highest level of undiagnosed diabetes – more than two-thirds of Africans (66.7%) who have diabetes are unaware they have it. But other regions also have high levels of undiagnosed diabetes – South Asia (52%), Middle East and North Africa (41%) and Latin America (39%). Even in high-income countries, about 36% of people with diabetes are undiagnosed. Of course, the earlier a person is diagnosed and management is initiated, the better the chances of preventing harmful and costly complications.

Modern lifestyle behaviors associated with urbanization are responsible for the growth of diabetes, including processed foods (with high fat content, sugar-sweetened beverages and refined carbohydrates) and physical inactivity and long sedentary periods. These behaviors are associated with increased risk of obesity and type 2 diabetes (which accounts for the vast majority of diabetes).

“However, in order to meet the 2025 target of no increase in diabetes, much more needs to be done,” says the seventh edition of Diabetes Atlas. “ Whole populations must change their lifestyle behaviors by modifying diet and increasing physical activity levels. To support this, IDF has reviewed the evidence on which types of food predispose to type 2 diabetes and has released nine recommendations for a healthy diet for the general population.

To combat this, IDF is calling on governments to improve education on the diagnosis and management of all types of diabetes, public health education to encourage behavior change and to take preventive action by taxing unhealthy foods starting with sugar-sweetened beverages, such as soft drinks. In 2015, IDF published its Framework for Action on Sugar, which recognizes the important role that excess sugar consumption has in increasing the risk of type 2 diabetes and presents policy initiatives aimed at reducing consumption of sugar and shifting to healthier foods.

In India, where more than 1 million people die of diabetes annually, Arogya World, a U.S. non-profit organization working to prevent NCDs, provides a tangible example of what can be done to combat diabetes. Earlier this month, Arogya World launched a new chronic disease prevention mobile app called “MyArogya” for working Indians. MyArogya has content on diabetes, heart disease, stroke and kidney disease, as well as food and activity trackers to help people make healthy lifestyle changes. Future plans include a smoking cessation program and healthy recipe videos among other features meant to appeal to working Indians.

“I think mHealth is a really smart solution to address NCDs in India where cell phones are so prevalent,” said Nalini Saligram, founder and CEO of Arogya World. Saligram says she hopes the app, funded by the Cigna Foundation, reaches 1 million working Indians in a few years.

Saligram said mDiabetes, an earlier text messaging program started in India in 2012, was successful in reaching a million people and showing positive health behaviors. Building on that success, Arogya World developed MyArogya, which has more content and will be better able to monitor health behavior.

On Dec. 1, the IDF will release the seventh edition of the Diabetes Atlas on this website.

A Global Health TV interview explains how the U.S. is winning the battle but losing the war in the fight against type 2 diabetes.