From the Editors
Global Diabetes Epidemic Rages On
upward trend shows no sign of abating, governments need to empower people to
make the necessary ‘lifestyle’ changes
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. Comparable figures were released by the World Health
Organisation (WHO): 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
In the United States, diabetes now
affects 25.8 million people of all ages, or 8.3 percent of the population, and
is the 7th leading cause of death; 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
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. 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. The researchers blamed the growing
popularity of junk food high in sugar and fat, as well as inadequate exercise
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. 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.
consequences of diabetes
if untreated, can damage the heart, blood vessels, eyes, kidneys and nerve. The
common consequences of diabetes are as follows.
risk of heart disease and stroke: 50 percent of people with diabetes die
of cardiovascular disease (primarily heart disease and stroke)
with reduced blood flow, neuropathy in the feet increases the chance of
foot ulcers and eventual limb amputation
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.
is among the leading causes of kidney failure; 10-20 percent of people
with diabetes die of kidney failure
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.
overall risk of dying among people with diabetes is at least doubled that
of their peers without diabetes.
cause the epidemic and what to do?
overweight and obesity among adults and children is generally regarded as a
major driver for the diabetes epidemic, along with a sedentary lifestyle. 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 . 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.
importance of physical activity was highlight 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), 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 The Food, Inc. Horror Movie, SiS 46).
Where ‘lifestyle’ changes fail, drugs are
used, although these carry a range of side effects, including the latest (see Treating
Diabetes with a Glucogon-like Peptide, New
Diabetic Drug & Cancer Risk, SiS 52). Consequently, traditional
interventions through common herbal and food medicines are becoming
increasingly popular (see Diabetes,
New Cures from Old Foods, SiS 52).
Fully referenced versions of this editorial and all
articles are available on ISIS members website: http://www.i-sis.org.uk/sismembers.php