Diabetes epidemic out of control – IDF

A staggering 285 million people worldwide have diabetes and the disease is affecting far more people of working age than previously believed, according to the latest figures released by the International Diabetes Federation (IDF) at the 20th World Diabetes Congress held in Montreal, Canada in late October.

The IDF says the epidemic is out of control and that low and middle-income countries (LMCs) are bearing the brunt of it.

Diabetes has become a development issue. In LMCs, it is a significant threat to health and economic prosperity. The IDF predicts that diabetes will cost the world economy at least US$376 billion in 2010, or 11.6% of total world healthcare expenditure. By 2030, this number is projected to exceed $490 billion. More than 80% of diabetes spending is in the world’s richest countries and not in the poorer countries, where more 70% of people with diabetes now live.

In 1990 the number of people with diabetes was put at 150 million worldwide. Now this figure has been revised to close to 300 million, with more than half aged between 20 and 60. The IDF predicts that if the current rate of growth continues unchecked, the total number will exceed 435 million in 2030.

Professor Jean Claude Mbanya, President of the International Diabetes Federation, voiced concern: “The data from the latest edition of the IDF Diabetes Atlas show that the epidemic is out of control. We are losing ground in the struggle to contain diabetes. No country is immune and no country is fully equipped to repel this common enemy.”

Type 1 diabetes is an autoimmune disease and cannot be prevented. However, of all diabetes 85%-95% of cases are type 2 diabetes and it is estimated 60% or more of these cases can be prevented.

Diabetes claims four million lives every year and is a leading cause of blindness, kidney failure, heart attack, stroke and amputation.

Diabetes now affects 7% of the world’s adult population. The regions with the highest comparative prevalence rates are North America, where 10.2% of the adult population have diabetes, followed by the Middle East and North Africa Region with 9.3%.

India is the country with the most people with diabetes, with a current figure of 50.8 million, followed by China with 43.2 million. Behind them the United States (26.8 million); the Russian Federation (9.6 million); Brazil (7.6 million); Germany (7.5 million); Pakistan (7.1 million); Japan (7.1 million); Indonesia (7 million) and Mexico (6.8 million).

When it comes to the percentage of adult population living with diabetes, the new data reveal the devastating impact of diabetes across the Gulf Region, where five of the Gulf States are among the top ten countries affected. The Pacific island nation of Nauru has the world’s highest rate of diabetes, with almost a third of its adult population (30.9%) living with the disease. It is followed by the United Arab Emirates (18.7%); Saudi Arabia (16.8%); Mauritius (16.2%); Bahrain (15.4%); Reunion (15.3%); Kuwait (14.6%); Oman (13.4%); Tonga (13.4%) and Malaysia (11.6%).

Child mortality declines, but not enough to meet MDGs

The latest figures from UNICEF show a decline in global child mortality.

The data shows that the mortality rate for children under five has dropped 28% in the past 8 years – from 90 deaths per 1000 live births in 1990, to 65 deaths per 1000 live births in 2008.

“Compared to 1990, 10,000 fewer children are dying every day,” said Ann M. Veneman, UNICEF Executive Director. However, she stressed that “while progress is being made, it is unacceptable that each year 8.8 million children die before their fifth birthday”. However, the trend is positive. The rate of the decline in the under-five mortality rate has increased since the 1990s. The average rate of decline from 2000 to 2008 is 2.3%, compared to a 1.4% average decline from 1990 to 2000.

Public health experts attribute the continuing decline to increased use of key health interventions, such as immunizations, including measles vaccinations, the use of insecticide-treated bed nets to prevent malaria and Vitamin A supplementation. Where these interventions have increased, positive results have followed.

Progress has been seen in every part of the world, and even in some of the least-developed countries. A key example is Malawi, one of ten high child mortality countries that is now on track to meet the Millennium Development Goal (MDG) of a two-thirds reduction in under-five mortality between 1990 and 2015.

The new data also shows that seven of the 67 high mortality countries (those with under-five mortality rates of 40 per 1000 live births or higher) have consistently achieved annual rates of reduction of under-five mortality of 4.5% or higher. These are Nepal, Bangladesh, Eritrea, Lao People’s Democratic Republic, Mongolia, Bolivia and Malawi.

While progress has been made in many countries, the global rate of improvement is still insufficient to reach the MDG, and Africa and Asia combined still account for 93% of all under-five deaths that occur each year in the developing world, with 40% of the world’s under-five deaths occur in just three countries: India, Nigeria, and the Democratic Republic of Congo.

In some countries, progress is slow or non-existent. In South Africa the under-five mortality rate has actually gone up since 1990, largely due to the AIDS epidemic in that country.

UNICEF says that progress can be accelerated even in the poorest environments, through integrated, evidence-driven, community-based health programmes that focus on addressing the major causes of death – pneumonia, diarrhoea, newborn disorders, malaria, HIV and under-nutrition.

Medical community ‘outside of climate change talks’

Despite an international resolution to avoid environmental health hazards, the medical community – already overburdened with health challenges – has remained largely outside the climate change dialogue, according to Diarmid Campbell-Lendrum, a World Health Organisation (WHO) climate change specialist.

“Climate change was seen as low-down on the list of priorities given that we have an agenda that has not been completely addressed – death of under-five children, for example. We have not fixed that problem. When presented with the climate change concern that [was seen] as just another competing agenda,” said Campbell-Lendrum, who works in WHO’s public health and environment department.

Though relatively scarce and mostly regional in scope, medical studies have linked warming temperatures to a possible increase in diarrhoeal diseases, malnutrition and malaria and a degradation of food safety.

To date, environmental health threats have largely been ineffective in mobilising health workers and donors to address climate change, said Campbell-Lendrum. “The way to get engagement is not to go and say 1,000 deaths are caused by malaria and that climate change will add 20% in 20 years time. You would get a shrug of the shoulder.”

Rather, a message that has encouraged more from the health arena to address climate change has been: “If we act to improve our health systems now, then we are in a better position to deal with climate change,” he said.

A May 2008 UN resolution urged member states to “develop health measures and integrate them into plans for adaptation to climate change”. While the UN has estimated it can cost up to US$12 billion a year as of 2030 to face the health consequences of climate change, it has also acknowledged in a recent work plan “important gaps in our knowledge” on climate-related health risks.

AIDS activists hail new single UN women’s body

AIDS activists around the world have welcomed a new UN General Assembly resolution to create a single agency to promote the rights and wellbeing of women, which they say is good news for women, who are bearing the brunt of the global AIDS pandemic.

“This is a historic opportunity to advance the rights of women and girls,” said UNAIDS executive director Michel Sidibé.

Under the new resolution, four UN agencies dealing with women’s issues – the UN Development Fund for Women (UNIFEM), the Division for the Advancement of Women, the Office of the Special Adviser on Gender Issues, and the UN International Research and Training Institute for the Advancement of Women (UN-INSTRAW) - will be merged to form a new, consolidated body headed by an under-secretary general.

Some activists say the move is long overdue, calling the UN's response to women's issues so far a “lamentable failure”.

“Thirteen years after UNAIDS was established, and even with the subsequent horrendous toll of the pandemic on women and global recognition of the feminisation of AIDS, there is no organisation representing women on the committee that steers UNAIDS’ work,” said AIDSFree World, an international NGO that advocates a more effective global response to HIV.

Women make up 60% of people living with AIDS in sub-Saharan Africa, a figure that rises to 75% in the 15-24 age range. In Asia, nearly 50 million women are at risk of becoming infected with HIV from their partners.

“We don’t see the UN’s presence – beyond the policy level – supporting networks on the ground, deep in the villages where women and children affected by HIV have very poor access to health care,” Marion Natukunda, project director for the grass-roots Ugandan NGO, Mamas Club, told IRIN/PlusNews.

“We hope the new agency will help with advocacy around women’s issues, and will lead to more grass-roots support for HIV-positive women,” she added.

Facebase to house craniofacial data

Although about half of all birth defects involve the face and skull, scientists remain unclear about why most occur. To help families at risk for these conditions, what’s needed is a comprehensive and systematic understanding of how the faces of healthy children develop and what goes awry to cause common malformations. With today’s improved technologies, researchers can generate megabytes of information in a single experiment on hundreds of genes that are involved in the process. The challenge now is to learn how best to integrate this information into a meaningful whole, while adding new data to form a more comprehensive picture of this complex developmental process.

The integration process just got a lot easier. The US National Institute of Dental and Craniofacial Research, part of the National Institutes of Health, recently issued the first 11 research and technology grants of its new FaceBase Consortium. The five-year initiative will systematically compile the biological instructions to construct the middle region of the human face and precisely define the genetics underlying its common developmental disorders, such as cleft lip and palate. The mid-face includes the nose, upper lip, and the palate, or roof of the mouth.

As a key part of the initiative, a one-stop, encyclopaedic database of head and skull, or craniofacial, development will be created and maintained to allow scientists to mine the riches of the information enabling them to more rapidly and effectively generate hypotheses and accelerate the pace of their research. The database, called FaceBase, will be free and publicly accessible to the scientific community. Its organisers anticipate that FaceBase will have a prototype ready within the next year and a fully functioning database soon after.

Health informatics programmes funded

The US-based Fogarty International Center will award more than US$9.23 million to eight global health informatics programmes over the next five years. Fogarty’s Informatics Training for Global Health programme is intended to increase informatics expertise in low- and middle-income countries by training scientists to design information systems and apply computer-supported management and analysis to biomedical research. Medicine and biomedical research are knowledge-based fields that depend upon the sharing of information. Informatics, the science of handling large volumes of information, can help link physicians and researchers around the world so that they can share knowledge ranging from the best care of patients to issues in collaborative research. The grants will help support the developments of health informatics in South Africa, Kenya and a number of countries in South America.

Largest international registry on CAD to boost knowledge

CLARIFY, the largest international registry to ever be carried out in stable coronary artery disease (CAD) outpatients was launched 31 August in around 40 countries worldwide, at the European Society of Cardiology (ESC) Congress.

The CLARIFY registry (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is designed to increase knowledge and understanding of CAD. Most of the data available on CAD stem from randomised clinical trials, which have limited generalisability due to the stringent selection process of participants, or include patients hospitalised for acute events or procedures or focus on patients with anginal symptoms. There is only limited data regarding stable outpatients with CAD, their contemporary management and outcomes. The new registry is designed to provide important epidemiological and clinical data, including an assessment of the role of heart rate in the prognosis of CAD patients, and will hopefully help improve disease management by identifying gaps between evidence and actual practice.

CAD remains the leading cause of death worldwide and is predicted to remain so for the next 20 years (according to: Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006). An improved understanding of the management and outcomes of these patients is essential to reducing the disease burden.

CLARIFY will involve a minimum of 30,000 outpatients with stable CAD from around 40 countries worldwide, who will be followed for five years.

Novel drug for type 2 diabetes set to undergo clinical trials

SynCo Bio Partners, a Netherlands based biopharmaceutical contract manufacturer, and Versartis, have formed a strategic partnership to produce Versartis’ lead drug candidate VRS-859, a novel GLP-1 analog for monthly dosing to treat type 2 diabetes. It is expected that Phase 1 clinical trials for VRS-859 will begin in the first half of 2010. Under the agreement, SynCo will further develop the Versartis existing manufacturing and production process for VRS-859.

VRS-859 is a recombinant fusion protein containing exenatide and ‘XTEN’, a novel hydrophilic amino acid sequence that prolongs the half life of proteins and peptides. New therapeutic compounds using the XTEN technology are expected to provide enhanced stability and less frequent dosing requirements with potentially fewer patient side effects.

“Versartis selected SynCo because of its extensive pharmaceutical manufacturing experience and its ability to deliver bulk and final product for clinical trials and ultimately, for commercialisation,” said Jeffrey L. Cleland, PhD, Founder and Chief Executive Officer of Versartis.

Talking Glossary of Genetic Terms

The US-based National Human Genome Research Institute (NHGRI) has launched the next generation of its online Talking Glossary of Genetic Terms. The glossary contains several new features, including more than 100 colour illustrations and more than two dozen 3-D animations that allow the user to dive in and see genetic concepts in action at the cellular level.

The updated glossary gives students, teachers and the public a reliable online resource for more than 200 terms and basic concepts behind today’s breakthroughs in genetics and genomics. The glossary is available at: www.genome.gov/glossary 


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