Beware the oncoming wave of diabetes

  • Health
  • Sunday, 16 Nov 2014

The most frightening statistic for Sir Michael Hirst is the 46 of diabetics who remain undiagnosed, untreated and at risk of developing the many complications of the disease. - Novo Nordisk

The world is facing a diabetic pandemic of massive proportions, if nothing is done now.

International Diabetes Federation (IDF) president Sir Michael Hirst believes that the diabetes pandemic is a tsunami in the making.

This lifestyle disease may be non-communicable, but the number of people affected by it is rapidly rising around the world.

Speaking to international media at pharmaceutical company Novo Nordisk’s Favrholm, Denmark, campus recently, Sir Michael shared how when IDF was campaigning for a United Nations resolution on diabetes in 2006, they were warning that the number of diabetics would increase to 360 million worldwide by 2025, if nothing was done.

“2025 hasn't come, but we are a long way ahead of 360 million,” he said.

In fact, the federation, which publishes an annual Diabetes Atlas, calculated that the number of diabetics in the world as of last November was already 382 million.

And that number is only expected to rise.

By 2035, the number of people living with diabetes is estimated to increase by 55% to 592 million. (See Diabetes digits)

But that is not the number that scares Sir Michael the most.

“For me, the most chilling number, the most sobering statistic on that graphic, is the estimated 46% – nearly half of the people on the planet who have diabetes – who have not yet had it diagnosed,” he said.

“Without diagnosis, there is no treatment. And without treatment, there are corollary disease complications of diabetes – the strokes and heart attacks.

“And very often, the person only discovers that they have diabetes after a heart attack, or after a TIA (transient ischaemic attack) or stroke; or when their sight starts to become affected by retinopathy; or when they start to have kidney problems.”

A big part of the problem is that diabetes can be quite a silent disease in its first few years.

People suffering from it do not always exhibit symptoms. And those who do show typical symptoms like increased thirst, fatigue and frequent urination, especially at night, might not always recognise them for what they are.

More insidious is the condition known as pre-diabetes, where a person’s blood sugar levels are consistently higher than normal, but not high enough to be diagnosed as diabetes.

Research has shown that the damage diabetes does to both the small and large blood vessels in our body, which results in diabetic complications like heart attacks, strokes, loss of sensation (neuropathy), loss of vision (retinopathy) and kidney failure, can start in the pre-diabetic stage.

Sir Michael shared that the number of people with pre-diabetes was estimated to be 316 million last November.

“So, if you like, this is a conveyor belt of new cases of diabetes, which is going to swell the numbers in years to come,” he said.

“And as though that’s not bad enough, it’s then estimated that by 2035 that number will grow to 471 million.”

He added that this means that in 21 years’ time, there will be over a billion people in the world having, or at risk of developing, diabetes.

With the United Nations estimating that the world population will be around 8.7 billion at that time, this means that around one in eight people will have diabetes or be on their way to having it.

It’s both personal and national

As a disease strongly associated with diet and obesity, type 2 diabetes was once thought to be a ‘rich man’s disease’.

However, the numbers continue to show the misconception that this is.

Of the 10 countries with the most number of diabetics, seven of them are developing nations. They are, in descending order, China, India, Brazil, the Russian Federation, Mexico, Indonesia and Egypt.

The list is rounded out by the United States in third position, Germany in eighth, and Japan as number 10.

Of these countries, the top three alone – China, India and the US – house almost half the world’s population of diabetics.

Said Sir Michael: “Four out of five people with diabetes today live in low- and middle-income countries.

“And in years to come, the majority of new cases will occur in developing countries.”

But more frightening is the estimate that 86% of these people will be of working age.

“Just think what this means to developing countries.

“The people that they are relying on to be productive members of society will either be incapacitated with diabetic complications or dead,” he said.

This human cost of lost productivity and disease burden, he felt, was the largest cost of diabetes; even more so than the actual cost of treating diabetes and its complications, estimated to be US$548bil (RM1.83tril) worldwide in 2013 and US$627bil (RM2.09tril) by 2035.

In addition, there is the cost to the family of the diabetic.

“In far too many cases, the diagnosis of diabetes means a restrictive life for that person’s family, and lost opportunities for that person,” he said.

The former businessman and politician spoke from experience as his youngest daughter, now in her 30s and on insulin, was diagnosed with type 1 diabetes at the age of five.

The cost of diabetes

The number of deaths due to diabetes was estimated to be 5.1 billion last year – a number, Sir Michael noted, that exceeded the number of deaths caused by HIV, tuberculosis and malaria combined.

He also warned against believing that this was the actual number of diabetic deaths.

“When a person dies of a stroke or a heart attack, it is reported on the death certificate as cardiac arrest or stroke. Or they die of end-stage renal failure, and it is described as that.

“But the real cause of the death is diabetes with the secondary complication of heart attack, or stroke, or end-stage renal failure.”

Aside from deaths, diabetic complications are also an important cause of disability among its sufferers.

“The greatest cause of blindness among young people is through diabetic retinopathy.

“The greatest number of amputations that take place across the world are through neuropathic disorders rather than traumatic injuries,” he said.

Sir Michael also pointed out that many people with diabetes also suffer from depression.

“The mental health aspect is one, which is not getting the priority that it deserves,” he opined.

Psychology plays an important part in the diabetes epidemic, especially in those at risk of type 2 diabetes, which is heavily influenced by a person’s lifestyle.

“Type 2 diabetes can be avoidable for many people if they are able to make the changes in their lifestyle, in their diet, in the exercise that they do, in the belief that they ought to be responsible for their own body,” he said.

He admitted: “Many people find it hard, and there’s probably not enough being done to look into the psychology of behavioural change to help these people make these lifestyle adjustments.”

And while people have the responsibility to look after their own health, Sir Michael also believes that governments have a vested interest in ensuring that their people live healthily.

“I don’t believe that health should be looked at as a cost, it should be looked at as an investment.

“A healthy population is a productive population.”

> See next Sunday’s Fit for Life for Novo Nordisk’s latest diabetic drug developments.

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