Diabetes

∴ A look at the current situation

• At present, 177 million people worldwide suffer from diabetes. This figure will probably more than double its current amount by the year 2030. • Each year, about four million deaths from the complications of diabetes occur in the world. • The 10 countries with the highest number of people with diabetes are, in order: India, China, the United States of America, Indonesia, Russia, Japan, the United Arab Emirates, Pakistan, Brazil, and Italy. • The direct healthcare costs of diabetes account for 2.5%–15% of the annual healthcare budget, an amount that depends on the prevalence of diabetes in the region and the type of treatments provided. • Based on information obtained from 25 Latin American countries, the costs of reduced productivity due to diabetes are 5 times greater than the direct healthcare costs. • Recent studies in China, Canada, the United States, and several European countries have shown that bringing about changes in lifestyle can prevent the onset of diabetes in people who are at risk of developing it.

∴ The costs of diabetes • A diabetes epidemic is on the verge of occurring. In 1985, about thirty million people worldwide had diabetes. A decade later, the number of people with diabetes in the world reached 135 million.

• The latest survey by the World Health Organization in 2000 shows that the number of people with diabetes worldwide amounts to 177 million, and this figure will probably reach at least 370 million by the year 2030. There are two main concerns in this regard. First, a major part of the increase in diabetes cases occurs in developing countries and is due to population growth, the aging of the population, an unhealthy diet, obesity, and physical inactivity. Second, the incidence of type 2 diabetes, which makes up 90% of all diabetes cases, is increasing at younger ages. By the year 2030, most people with diabetes in developed countries will be around 65 years of age or older, whereas these individuals in developing countries will be in the age range of 45–64 years, that is, the most productive years of life.

• The number of deaths from diabetes in the world amounts to more than 800,000 cases each year. Of course, the cause of death of most diabetic individuals is other chronic diseases such as cardiovascular diseases.

• Diabetes mellitus is a chronic disease that arises due to the inherited or acquired inability of the pancreas to produce insulin or the ineffectiveness of the insulin produced. This defect causes an increase in the concentration of blood glucose, and consequently many of the body's systems, especially the vessels and nerves, are damaged. In people who have impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), the likelihood of developing diabetes or cardiovascular diseases is much greater than in people whose glucose tolerance is normal.

∴ Types of diabetes

Type 1 diabetes:

(formerly known as insulin-dependent diabetes) in which the pancreas is unable to produce insulin, which is essential for sustaining life and regulating blood sugar. This form of diabetes most often develops in children and adolescents, but it can also occur at older ages.

Type 2 diabetes:

(formerly known as non-insulin-dependent diabetes or adult-onset diabetes). Most diabetic individuals have this type of diabetes. This form of diabetes arises due to the body's inability to respond properly to the insulin produced in the pancreas. Type 2 diabetes most often develops in adults, but cases of children and adolescents developing this disease are also increasing.

∴ Complications of diabetes mellitus

1/ Cardiovascular diseases:

These are the cause of about 50% of all deaths in people with diabetes in industrialized countries. The risk factors for heart disease in people with diabetes include high blood pressure, high serum cholesterol levels, obesity, and smoking. Identifying and controlling these risk factors can delay or prevent the onset of heart diseases in people with diabetes.

2/ Neural complications:

This is probably the most common complication of diabetes. Studies show that about 50% of diabetic individuals suffer from various forms of this disorder. The most important risk factors for this disorder are the level and duration of elevated blood glucose. Neuropathy can lead to reduced sensation in the limbs and damage to them. This disorder is also one of the main causes of sexual weakness in diabetic men.

3/ Eye complications:

This is considered one of the main causes of blindness and weak vision. Research findings show that about 2% of diabetic individuals become blind 15 years after developing diabetes, and about 10% of them also develop weak vision.

4/ Kidney failure:

This is another complication of diabetes, and diabetes is among the main causes of this failure. But this varies among different societies and also depends on the severity and duration of the disease.

5/ Foot ulcers:

These, which arise due to changes in the blood vessels and nerves, often lead to ulceration and subsequently to amputation of the foot. Diabetes is the most common cause of non-traumatic amputation of the lower limbs.

∴ Prevention and treatment:

• Primary prevention:

• A healthy diet and regular physical activity will protect people who are at risk of developing diabetes.

• Primary prevention reduces or postpones the need for the care and treatment of diabetes complications.

• Prevention should be emphasized especially in the poorest regions of the world, which face severe resource constraints.

• Secondary prevention:

• This includes early identification and the provision of appropriate treatments. Treating high blood pressure and elevated blood lipids, as well as controlling blood glucose levels, can reduce the risk of complications developing and slow their progression.

• Large population studies in China, Canada, the United States of America, and several European countries have shown that weight loss (even a small amount) and half an hour of walking per day cause the incidence of diabetes to be halved in people who have excess weight along with a mild impairment in their glucose tolerance test.

• Due to the chronic nature of the disease as well as the severity of its complications and the methods used to control those complications, this disease is very costly not only for patients and those around them, but also for the country's health officials.

• Surveys conducted in India have shown that in a low-income Indian family that has an adult member with diabetes, about 25 percent of the family's income is allocated to diabetes care.

• This figure for an American family that has a child with diabetes is about 10 percent.

• In an analysis recently conducted regarding healthcare costs in the Western Pacific region by the World Health Organization, it was found that 16% of hospital costs are related to diabetic individuals.

• In the country of Fiji, 20% of ancillary health expenses are spent on diabetes complications. Due to the lack of certain treatment facilities in this country, diabetic patients are forced to travel to other countries in order to access those facilities. Such costs, which are spent on matters related to preventable diseases, are very heavy for poor countries.