The number of cases of diabetes in developing countries is likely to increase more than two-fold in the next 30 years, from 115 million in 2000 to 284 million in 2030. WHO has marked World Diabetes Day, 14 November, 2003, with a commitment to increase its efforts to reduce the impact of diabetes and its complications, particularly among low- and middle-income communities, in collaboration with the International Diabetes Federation (IDF).
"Diabetes is part of the growing epidemic of noncommunicable diseases (NCDs) that are beginning to impose a double burden of disease on the world's poorest countries," said Dr Catherine Le Galès-Camus, WHO Assistant Director-General, Noncommunicable Diseases and Mental Health. "Even as these countries are struggling to address the problems of HIV/AIDS, malaria and tuberculosis, they must also prepare to deal with the onslaught of diseases that come with changes in lifestyle and ageing of their populations."
The good news, said Dr Le Galès-Camus, is that much of the projected increase in diabetes is preventable, through attention to diet and physical activity in the population. WHO is currently developing a Global Strategy on Diet and Physical Activity, which will underpin its efforts to help Member States prevent diabetes and other diseases related to unhealthy diets and physical inactivity.
For those who have diabetes, good management of the disease can delay or even prevent complications and disability.
Promoting self management by patients, proactive control of risk factors by health professionals and reorganization of health services to manage chronic conditions have all been shown to make a significant difference to patients", said Dr Rafael Bengoa, WHO, Director, Management of Noncommunicable Diseases. "We will be working with countries to find ways to deliver a minimum package of care in even the poorest settings. Prevention and management go hand in hand. We need to provide comprehensive packages that meet the needs of all members of the community, and that address the disease at all stages and in all its manifestations."
The burden of disease associated with diabetes is substantial: at least one in 20 deaths worldwide is attributable to diabetes. In financial terms, direct health care costs range from 2.5% to 15% of annual health care budgets, and indirect costs such as loss of production may be five times this number.
Diabetes is a chronic disease characterized by having too much glucose in the blood because the body is not producing insulin or not using insulin properly. Some 90% of the world's estimated 171 million people with diabetes have type 2 diabetes. This used to be considered a disease of older people and rich countries, but the majority of people with diabetes in Africa are between 45 and 64 years.
"All over the world, peoples lifestyles are changing," said Dr Le Galès-Camus. "We are less active than our parents and grandparents, and we eat food with higher concentrations of sugars and fats, often with the result that we are putting on weight, and increasing the risk of diabetes. Add to this the fact that populations are ageing, and it is easy to see why diseases such as diabetes are on the increase."
China provides a graphic example. Diabetes is already a substantial concern, with 21 million cases in the year 2000, or one in every 60 people. Obesity is on the rise - a recent study showed that even among Chinese pre-school children, obesity rates increased tenfold to affect one in every 10 children over an eight-year period. This extra weight increases their risk of diabetes as they grow older.