Diabetes has correctly been labeled as the “silent epidemic” – its non-dramatic, insidious and chronic nature often masks the menace inflicted by the disease through death, incapacitation, and negative impact on quality of life of patients as they spend years coping with their life-changing affliction.
The World Health Organization is one of several organizations that monitor the worldwide patterns in diabetes. Some of the salient points extracted from recent reports on the state of diabetes clearly highlight the life-threatening nature o the disease and its alarming rise in frequency:
Worldwide 3.2 million diabetes-related deaths are reported annually, a number equivalent to that of HIV/AIDS-related deaths.
One in every 20 deaths is attributed to diabetes equating to 8,700 deaths per day, or 6 deaths every minute.
In the age group of 35-64 years, 1 out of 10 deaths are attributed to diabetes, a ratio that increases to 1 out of 4 in certain vulnerable populations.
Diabetes contributes significantly to premature adult mortality – out of all deaths of diabetic people under the age of 35, three-fourths are attributable directly to the disease.
Based on 2005 figures, at least 171 million people worldwide have diabetes. This number is expected to double by the year 2030.
The condition is worse in developing countries, where the number of people afflicted by the disease are expected to increase by 150% by the year 2030.
Why is there an increasing trend in the incidence of diabetes? In the past, most diabetics were known to have a genetic tendency towards the disease. However, that trend has rapidly given way in the past few decades to other causes, at least from a statistical perspective. These genetically-independent trends that explain the growth in the incidence of diabetes can be summarized as follows: (a) overall growth in population, (b) increased life expectancy resulting in a higher ratio of aged population more prone to diabetes, (c) increasing obesity trends, (d) unhealthy diets and (e) sedentary lifestyles.
In other words, diabetes has increasingly become a lifestyle-related disease as it afflicts young and old, in developed and developing nations, around the world. As the number of patients grows across the globe, there has never been a stronger and more urgent need for therapeutic measures that arrest the growth of the disease and alleviate its secondary manifestations.
Figure 1.1. Worldwide prevalence of diabetes obtained from the “Diabetes Action Now” booklet information posted for on the World Health Organization website.
Diabetes in Developing Countries
The map shown is Figure 1.1 obtained from the WHO, shows the areas of the world that are worst affected by diabetes. As can be seen clearly in this map, diabetes afflicts two separate sections of the world:
Firstly, in the developed world, while diabetes has become a more mainstream disease, a large proportion of the patients are near or past the age of retirement. In the next section, facts and figures also show an increase of incidence in younger adults, largely as a function of lifestyle related parameters. But these changes are not as marked as they are in developing countries.
The map clearly illustrates South and South East Asia, the Middle East and parts of Northern Africa as the worst affected regions in the developing world. Both India and China have the largest number of diabetes patients, partly owing to their large populations. It is also well known that, in the developing world, the reported number of deaths related to diabetes is grossly underestimated - poor surveillance and improper management of death records militates against clearly understanding the full impact of the disease.
What separates diabetes in the developing world from that in the developed world is its rapidly increasing incidence of the disease in the younger age group of 20-44 and 45-64 years. The graphs in Figure 1.2, obtained from the World Health Organization, illustrate the incidence of diabetes for different age brackets in both developed and developing nations, as well as its projected growth in the year 2030.
Figure 1.2. Worldwide prevalence of diabetes obtained from the “Diabetes Action Now” booklet information posted for on the World Health Organization website.
The WHO unambiguously states: “The biggest impact (of diabetes) is on adults of working age in developing countries”.
Figure 1.3. Diabetes growth maps for the United States between 1990-2001.
Diabetes in the Developed World: The U.S. Example
In the United States alone, diabetes is currently the sixth largest cause of mortality, with approximately 21 million people (almost 7 per cent of the total population) suffering from the disease. This number is expected to more than double to almost 50 million by the year 2050. From the perspective of diagnostic awareness, 30 per cent of these cases involve people who do not as yet know that the disease afflicts them, and are not taking prophylactic measures to prevent its further growth. Given the insidious nature of the disease, there is a growing population of “prediabetics” as well who demonstrate impaired glucose tolerance and/or impaired fasting glucose levels that cannot be classified as “diabetic” within the parameters that define the disease. According to the Center for Disease Control (CDC) in the United States, approximately 41 million people, amounting to almost one-fifth of the population in the United States, were estimated to be prediabetic in the year 2000.
The maps in Figure 1.3 posted by the CDC clearly illustrate the epidemic increase in the incidence of diabetes. While genetic tendencies towards diabetes continue to play their share, the explosion of the disease in recent years has its roots in the inactivity and poor eating habits in large segments of population promoted by available lifestyle choices and socioeconomic factors. The relationship between obesity and diabetes is very well documented. Comparing the diabetes maps in Figure 1.3 with the corresponding obesity trends for adults, in Figure 1.4 provides its own compelling story.
Running parallel to the obesity-diabetes axis is the steep growth of the obesity rate in children and adolescents that leaves them prone to cardiovascular risks as well as the incidence of Type 2 diabetes at a relatively young age, thus providing the impetus for diabetes to become a leading epidemic of the twenty first century.
Figure 1.4. Obesity growth maps among adults in the United States measuring percentage of adults in the United States with a BMI ≥ 30 (~30 lbs overweight) over the years 1985-2006.
According to the National Health and Nutrition Examination Survey by the CDC, about one-third of children and adolescents in the United States were either overweight or at risk of becoming overweight (Figure 1.5). Given that 80% of all obese children in the age range of 10-15 years become obese adults, a grim picture can be visualized and even statistically extrapolated for the increasing incidence of lifestyle-related diabetes and cardiovascular disease.
According to figures presented in 2002 by the American Diabetes Association, the treatment of diabetes in the United States accounted for $132 billion, including both direct and indirect costs. While it is widely recognized that physical activity and nutritionally balanced diets are critical to the prevention of most lifestyle-related cases of diabetes, huge socio-economic barriers need to be surmounted to effectively implement this solution. In the meantime, the development of therapies to cure the direct and indirect consequences of diabetes has taken on a new significance.
Figure 1.5. Obesity trends in children and adolescents: age-range dependent percentages of obese children and adolescents based on the National Health and Nutrition Examination Survey by the CDC.
The world statistics presented in this chapter clearly demonstrate the epidemic nature of diabetes. No fireworks, just a simple, silent but deadly epidemic. Corrective measures that enable diabetics around the world live fulfilled, productive lives are critical to achieving the essential goal of controlling diabetes in the world health agenda. Raising the awareness of the general population to the prevalence of the disease is an important aspect of controlling the rampant epidemic. Enhanced surveillance, raising standards of diagnosis and treatment that can afford rapid detection and corrective measures, can ensure that the disease is either prevented (or at least delayed) in individuals with impaired glucose tolerance. Widespread lifestyle-directed counseling and availability of medications and preparations that control blood sugar levels are critical ingredients to this process.