Editorial

Combating the rising wave of Diabetes

Combating the rising wave of Diabetes

Since 2006, November 14, every year has been set aside by the United Nations (UN) and World Health Organisation WHO to discuss and proffer solutions to the world’s deadliest disease called diabetes. According to the WHO, the World Diabetes Day, 2017 campaign promotes affordable and equitable access for all women with diabetes or at risk of diabetes to the essential medicines and technologies, self-management education and information they require to achieve optimal diabetes outcomes and strengthen their capacity to prevent type 2 diabetes.

It is believed that about 8 percent of women – or 205 million women – live with diabetes worldwide, with over half of this figure in South-East Asia and the Western Pacific. During pregnancy, high blood glucose substantially increases the risk to health for both mother and child as well as the risk of diabetes for the child in the future. Almost half of the women who die in low-income countries due to high blood glucose, die prematurely, before age 70.

Diabetes is a major cause of blindness, kidney failure, heart attack, stroke and lower limb amputation. Healthy diet, physical activity and avoiding tobacco use can prevent or delay type 2 diabetes. In addition, diabetes can be treated and its consequences avoided or delayed with medication, regular screening and treatment for complications. Ensuring such actions forms part of the recommendations of WHO’s Global Report on Diabetes, launched in 2016. What makes women even more vulnerable are gender roles and power dynamics which impacts how they access healthcare services and their attitude towards the condition.

According to the International Diabetes Federation, there are over 199 million women with diabetes at present around the world, a statistic which is expected to rise to 313 million by 2040. Additionally, for women, diabetes is the ninth leading cause of death around the world, causing 2.1 million deaths annually. Women go through several phases during their lifetimes, from puberty to child birth to menopause. Combined with other factors, women tend to gain weight after each of these phases.

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Beyond women, a global report on diabetes indicates that over 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. The global prevalence of diabetes has nearly doubled since 1980, rising from 4.7 percent to 8.5 percent in the adult population. This reflects an increase in associated risk factors such as being overweight or obese.

Over the past decade, diabetes prevalence has risen faster in low and middle-income countries than in high-income countries. Diabetes caused 1.5 million deaths in 2012. Higher-than-optimal blood glucose caused 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. 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.

What are the health and economic and social implications and complications associated with Diabetes?  We are told by experts that Diabetes of all types can lead to complications in many parts of the body and can increase the overall risk of dying prematurely. Possible complications, according to experts, include heart attack, stroke, kidney failure, leg amputation, vision loss and nerve damage. In pregnancy, poorly controlled diabetes increases the risk of foetal death and other complications.

Diabetes and its complications bring about substantial economic loss to people with diabetes and their families and to health systems and national economies through direct medical costs and loss of work and wages. While the major cost drivers are hospital and outpatient care, a contributing factor is the rise in cost for analogue insulins 1 which are increasingly prescribed despite little evidence that they provide significant advantages over cheaper human insulins.

However, the report offered a lifeline in the sense that the disease could still be prevented. According to medical experts, type 1 diabetes cannot be prevented with current knowledge. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, and workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids. Taking a life-course perspective is essential for preventing type 2 diabetes, as it is for many health conditions. Early in life, when eating and physical activity habits are formed and when the long-term regulation of energy balance may be programmed, there is a critical window for intervention to mitigate the risk of obesity and type 2 diabetes later in life.

No single policy or intervention can ensure this happens. It calls for a whole-of-government and whole-of-society approach, in which all sectors systematically consider the health impact of policies in trade, agriculture, finance, transport, education and urban planning – recognising that health is enhanced or obstructed as a result of policies in these and other areas.

The overriding negative implications of the disease imply that countries and policy makers must take a series of actions, in line with the objectives of the WHO Global Action Plan 2013–2020, to reduce the impact of diabetes. They must establish national mechanisms such as high-level multi-sectoral commissions to ensure political commitment, resource allocation, effective leadership and advocacy for an integrated non-communicable disease, NCD, response with specific attention to diabetes. They must build the capacity of ministries of health to exercise a strategic leadership role, engaging stakeholders across sectors and society. Set national targets and indicators to foster accountability. Policy makers and governments must ensure that national policies and plans addressing diabetes are fully costed, funded and implemented. They should prioritise actions to prevent people becoming overweight and obese, beginning before birth and in early childhood. They also need to implement policies and programmes to promote breastfeeding and the consumption of healthy foods and to discourage the consumption of unhealthy foods, such as sugary drinks as well as to create supportive built and social environments for physical activity.

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