World Health Day

Diabetes in the sportlight

There are now more than 422 million people worldwide with diabetes. It is pandemic and is a global public health issue. The WHO issued its first ‘Global report on diabetes’ to coincide with World Health Day on 7 April – with a call to improve preventive measures and, for diabetics, to
better manage the condition. Middle East Health reports.

World Health Day was marked on 7 April with a call by the WHO to better manage diabetes for people who already have the condition and to improve prevention of the disease.

“Actions are needed both by governments and by people themselves,” says Dr Ala Alwan, WHO Regional Director for the Eastern Mediterranean. “While individuals need to take responsibility for their own health through maintaining a healthy lifestyle, governments are responsible for creating environments that promote healthy living and for establishing measures that reduce the exposure of the population to risk behaviours that can lead to diabetes.”

Since 1980, the number of adults with diabetes worldwide has quadrupled from 108 million to 422 million in 2014, according to a new study published in The Lancet. The findings provide the most comprehensive estimates of worldwide diabetes trends to date and show that diabetes is fast becoming a major problem in low and middle income countries.

Professor Majid Ezzati, from Imperial College London, and senior author of the study, says: “Diabetes has become a defining issue for global public health. An ageing population, and rising levels of obesity, mean that the number of people with diabetes has increased dramatically over the past 35 years.

“Rates of diabetes are rising quickly in China, India, and many other low and middle income countries, and if current trends continue, the probability of meeting the 2025 UN global target is virtually non-existent.”

Diabetes is a pandemic that remains hidden throughout most of the world, with up to half of all people with diabetes worldwide remaining undiagnosed. WHO projects that diabetes will be the 7th leading cause of death by 2030.

In the Eastern Mediterranean Region, 14% of the population has diabetes. Studies indicate that in some countries, more than 20% of adults have diabetes.

According to the study published in The Lancet, between 1980 and 2014, diabetes has become more common among men than women. Global age-adjusted prevalence of diabetes doubled among men (4.3% to 9.0%) and increased by twothirds among women (5.0% to 7.9%).

Although there was an increase in overall rates (crude prevalence) of diabetes in many countries in Western Europe, ageadjusted rates were relatively stable suggesting that most of the rise in diabetes in Western Europe between 1980 and 2014was due to the ageing population. In contrast, rates of diabetes increased significantly in many low and middle income countries – such as China, India, Indonesia, Pakistan, Egypt and Mexico. No country saw a significant decrease in diabetes prevalence.

The study did not differentiate between type 1 and type 2 diabetes, but most (85-95) of cases of adult diabetes are type 2 so the observed rise is likely to be due to increases in type 2 diabetes.

Professor Ezzati notes: “Obesity is the most important risk factor for type 2 diabetes and our attempts to control rising rates of obesity have so far not proved successful. Identifying people who are at high risk of diabetes should be a particular priority since the onset can be prevented or delayed through lifestyle changes, diet or medication.”

Eastern Mediterranean region

Diabetes is one of the four main noncommunicable diseases and with cancer, heart attacks and strokes, and lung disease, is responsible for 1.7 million deaths in the Region every year, according to the WHO. These diseases all share four main lifestyle-related risk behaviours, namely unhealthy diet, physical inactivity, tobacco use and inappropriate use of alcohol.

“Efforts to address the diabetes burden should be considered within the context of the overall efforts to combat the four main noncommunicable diseases,” says Dr Alwan.

“People with diabetes can live healthy and productive lives if the condition is diagnosed early and effectively managed by health care providers and by people themselves,” says Dr Alwan. Early detection and appropriate management – including the use of medications, lifestyle measures and regular follow-up – can prevent or slow the progression of the condition, and the development of complications.

Ineffective management of diabetes can lead to heart attacks, strokes, kidney failure, blindness, impotence, amputations and infections. The potential impact of simple diet modifications and increased physical activity on preventing and improving diabetes is huge. Individuals and governments can all take action to change current unhealthy behaviours, in order to reduce diabetes.

In its first “Global report on diabetes”, WHO highlights the need to step up prevention and treatment of the disease.

“If we are to make any headway in halting the rise in diabetes, we need to rethink our daily lives: to eat healthily, be physically active, and avoid excessive weight gain,” says Dr Margaret Chan, WHO Director- General. “Even in the poorest settings, governments must ensure that people are able to make these healthy choices and that health systems are able to diagnose and treat people with diabetes.”

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population- based studies with 4·4 million participants, The Lancet, 9 April 2016. n doi: 10.1016/S0140-6736(16)00618-8

It can be prevented

Diabetes can to a large extent be prevented or delayed through simple measures that can be taken by both individuals and governments.

Individuals can take these actions:

  • achieve and maintain a healthy body weight
  • become active and stay active throughout the life course
  • eat a healthy diet of between 3 and 5 servings of fruit and vegetables each day and reduce sugar, salt and saturated fat intake
  • avoid tobacco use – smoking increases the risk of heart attacks and strokes
  • Governments can take these actions:
  • conduct national public awareness campaigns on diabetes, diet and physical activity
  • create and protect physical environments that promote physical activity
  • regulate the marketing of unhealthy foods and non-alcoholic beverages to children
  • restrict the marketing of and increasing taxation on foods high in saturated fats and free sugars
  • subsidize the production and marketing of healthy food options
  • ensure free access to acceptable standard for health care for people with diabetes.

Governments should also implement certain key measures that reduce exposure to risk behaviours for heart attacks and strokes, which contribute significantly to complications and death among people with diabetes. These key measures focus on reducing the salt content of commercially produced foods, and reducing tobacco use and exposure to tobacco smoke.

Global report on diabetes

Among the key findings from the WHO’s “Global report on diabetes” are:

  • The number of people living with diabetes and its prevalence are growing in all regions of the world. In 2014, 422 million adults (or 8.5% of the population) had diabetes, compared with 108 million (4.7%) in 1980.
  • The epidemic of diabetes has major health and socioeconomic impacts, especially in developing countries.
  • In 2014, more than 1 in 3 adults aged over 18 years were overweight and more than one in 10 were obese.
  • The complications of diabetes can lead to heart attack, stroke, blindness, kidney failure and lower limb amputation. For example, rates of lower limb amputation are 10 to 20 times higher for people with diabetes.
  • Diabetes caused 1.5 million deaths in 2012. Higherthan- optimal blood glucose caused an additional 2.2 million deaths by increasing the risks of cardiovascular and other diseases.
  • Many of these deaths (43%) occur prematurely, before the age of 70 years, and are largely preventable through adoption of policies to create supportive environments for healthy lifestyles and better detection and treatment of the disease.
  • Good management includes use of a small set of generic medicines; interventions to promote healthy lifestyles; patient education to facilitate self-care; and regular screening for early detection and treatment of complications.

Global report on diabetes

Date of upload: 15th May 2016


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