Global Diabetes Epidemic Rages On

The upward trend shows no sign of abating, governments need to empower people to make the necessary ‘lifestyle’ changes Dr. Mae-Wan Ho

Relentless upward trend

The global diabetes epidemic continues on “a relentlessly upward trajectory”, according to officials from the International Diabetes Federation (IDF) and the European Association for the Study of Diabetes (EASD). The number of people with diabetes in 2011 has reached 366 million (up almost 30 percent from 2010); 4.6 million will die from the condition, and healthcare spending is now US$465 billion a year [1]. Comparable figures were released by the World Health Organisation (WHO) [2]: 346 million people worldwide have diabetes, and 3.4 million died from the condition in 2004. WHO estimates that in the period 2006-2015, China will lose US$558 billion in national income due to heart disease, stroke and diabetes alone.

In the United States, diabetes now affects 25.8 million people of all ages, or 8.3 percent of the population, and is the 7^th leading cause of death [3]; but only 18.8 million are diagnosed, with the remaining 7.0 million undiagnosed. Diabetes is hitting African Americans the hardest, with 4.9 million or 18.7 percent aged twenty and older affected [4].

The diabetes epidemic has been sweeping over the developing world with Southeast Asia among the hardest hit regions. India now has over 50 million people with type 2 diabetes, more than any other country in the world [5]. In 2010, the average age-adjusted prevalence of diabetes in India was 8 percent, higher than in most European countries. In 1928 and 1959, it was just 1percent or less.

In 2010, Australian and Vietnamese researchers from Sydney’s Garvan Institute of Medical Research found that about 11 percent of men and 12 percent of women in Vietnam’s Ho Chi Minh City had type 2 diabetes without even realizing it, in addition to the 4% of people already diagnosed with the condition [6]. The researchers blamed the growing popularity of junk food high in sugar and fat, as well as inadequate exercise (see later).  

The WHO statistics further reveals that type 2 (non-insulin-dependent) diabetes comprises 90 percent of cases, and until recently only seen in adults, but is now found in children [2]. The statistics also showed that more than 80 percent of diabetes deaths occur in low- and middle-income countries, and diabetes deaths are projected to double between 2005 and 2030.

Serious consequences of diabetes

Diabetes if untreated, can damage the heart, blood vessels, eyes, kidneys and nerve. The common consequences of diabetes are as follows [2].

• Increase risk of heart disease and stroke: 50 percent of people with diabetes die of cardiovascular disease (primarily heart disease and stroke)
• Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation
• Diabetic retinopathy is an important cause of blindness, occurring as a result of long-term accumulated damage to the small blood vessels in the retina; after 15 years of diabetes, ~ 2 percent of people become blind, and ~ 10 percent develop severe visual impairment.
• Diabetes is among the leading causes of kidney failure; 10-20 percent of people with diabetes die of kidney failure
• Diabetic neuropathy affects up to 50 percent of people with diabetes; although many different problems can occur, common symptoms are tingling, pain, numbness, or weakness in the feet and hands.
• The overall risk of dying among people with diabetes is at least doubled that of their peers without diabetes.

What cause the epidemic and what to do?

Growing overweight and obesity among adults and children is generally regarded as a major driver for the diabetes epidemic, along with a sedentary lifestyle [7]. Over the past 20 years, the rates of obesity have tripled in developing countries that have been adopting a Western lifestyle of decreased physical activity and overconsumption of cheap, energy-dense foods. The Middle East, Pacific Islands, Southeast Asia, and China face the greatest threat. The growing prevalence of type 2 diabetes, cardiovascular disease, and some cancers is linked to excess weight. It is estimated that 90 percent of type 2 diabetes is attributable to excess weight [8]. Population-based surveys of 75 communities in 32 countries found diabetes rare in communities in developing countries that have preserved a traditional lifestyle. By contrast, some Arab, migrant Asian Indian, Chinese, and US Hispanic communities that have undergone westernization and urbanization are at higher risk.

The importance of physical activity was highlighted in a study in Australia, which found that each hour per day spent in front of the TV is associated with an 18 percent increase in cardiovascular mortality (much of that associated in turn with diabetes) [5], even after controlling for other risk factors such as body weight, smoking, alcohol consumption and diet. In India, although the average prevalence of diabetes is 8 percent, it is only 0.7 percent for non-obese, physically active rural people, reaches 11 percent for obese, sedentary, urban dwellers, and peaking at 20 percent in the Ernakulam district of Kerala, one of India’s most urbanized states. Prevalence of diabetes is higher among affluent, educated urban Indians than among the poor, uneducated rural people; probably reflecting the ready availability of high-energy Western foods for the former as well as a more sedentary lifestyle. Prevalence of diabetes average 16 percent for urban Indians and only 3 percent for rural Indians. A similar concentration of diabetes among the urban population has been reported in many other Asian countries.

Fittingly, WHO emphasizes the importance of healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use in preventing or delaying the onset of type 2 diabetes. 

In addition, governments should devote much more effort into educating and empowering people to make these ‘lifestyle’ changes, by ensuring that healthy foods are widely available and affordable, and to restrict the sale of junk foods high in sugar, fat, salt, and monosodium glutamate,  especially for the young (see [9] The Food, Inc. Horror Movie, SiS 46).

Where ‘lifestyle’ changes fail, drugs are used, although these carry a range of side effects. Consequently, traditional interventions through common herbal and food medicines are becoming increasingly popular (see [10] Diabetes, New Cures from Old Foods, SiS 52)

Article first published 17/10/11

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References

1. “Diabetes epidemic on ‘relentlessly upward trajectory”, Martha Kerr, Medscpe Medical News, 13 September 2011, http://www.medscape.com/viewarticle/749572
2. Diabetes, WHO Fact Sheet No. 312, August 2011, http://www.who.int/mediacentre/factsheets/fs312/en/
3. National Diabetes Statistics, 2011, National Diabetes Information Clearinghouse, http://diabetes.niddk.nih.gov/dm/pubs/statistics/DM_Statistics.pdf
4. The Diabetes Epidemic Among African Americans, National Diabetes Education Program, January 2011, http://ndep.nih.gov/media/fs_africanam.pdf
5. Diamond J. Diabetes in India. Nature 2011, 469, 478-9.
6. “What cause the diabetes epidemic in Southeast Asia?” Heart Disease Prevention, 23 February 2011, http://howtopreventheartdisease.blogspot.com/2011/02/what-cause-diabetes-epidemic-in.html
7. “Unraveling the causes of diabetes”, Jean Marx, News, Science 2002, 296, 686-9.
8. Hossain P, Kawar B and El Nahas M. Obesity and diabetes in the developing world – a growing challenge. NEJM 2007, 356, 213-5.
9. Ho MW. The food, inc. horror movie. Science in Society 46, 46-47, 2010.
10. Saunders PT. Diabetes, new cures from old foods. Science in Society 52.