Diabetes is a chronic, potentially debilitating and often fatal disease. The disease occurs as a result of problems with the production and supply of insulin in the body. Either the body produces no or insufficient insulin (type 1 diabetes), or the body cannot use the insulin it produces effectively (type 2 diabetes). Insulin is a hormone made by the pancreas that helps ‘sugar’ (glucose) to leave the blood and enter the cells of the body to be used as ‘fuel’.

There are two main types of diabetes:

Type 1

Diabetes is sometimes called insulin-dependent, immune-mediated or juvenile-onset diabetes. It is caused by an auto-immune reaction where the body’s defence system attacks the insulin-producing cells. The reason why this occurs is not fully understood. People with type 1 diabetes produce very little or no insulin. The disease can affect people of any age, but usually occurs in children or young adults. People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood. If people with type 1 diabetes do not have access to insulin, they die.

Type 2

Diabetes is sometimes called non-insulin dependent diabetes or adult-onset diabetes. People with type 2 diabetes do not usually require injections of insulin. Usually, they can control the glucose in their blood by watching their diet, taking regular exercise, oral medication, and possibly insulin. Type 2 diabetes is most common in people older than 45 who are overweight. However, as a consequence of increased obesity among the young, it is becoming more common in children and young adults. Type 2 diabetes is the most common type of diabetes and accounts for 90-95% of all diabetes. If people with type 2 diabetes are not diagnosed and treated, they can develop serious complications, which can result in an early death. Worldwide, many millions of people have type 2 diabetes without even knowing it. Others do not have access to adequate medical care. The onset of type 2 diabetes is also linked to genetic factors but obesity, physical inactivity and unhealthy diet increase the risks.

Some women develop a third, usually temporary, type of diabetes called ‘Gestational Diabetes’ when they are pregnant. Gestational diabetes develops in 2-5% of all pregnancies, but usually disappears when the pregnancy is over. Women who have had gestational diabetes have an increased risk of developing type 2 diabetes later on.

Impaired Glucose Tolerance (IGT)

People with Impaired Glucose Tolerance (IGT) have glucose levels that are above normal but below the level at which diabetes is diagnosed. People with IGT have a significant risk of developing type 2 diabetes. They are thus an important target group for primary prevention. Changes in lifestyle, including diet and physical activity can greatly reduce the onset of diabetes.

 

Symptoms Of Diabetes

Diabetes Complications

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

  • Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke).
  • Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation.
  • Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2% of the people become blind, and about 10% develop severe visual impairment.
  • Diabetes is among the leading causes of kidney failure. 10-20% of the people with diabetes die of kidney failure.
  • Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of the people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands.
  • The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

  

Diabetes Diagnosis

Diabetes is a preventable and controllable disease.

Preventing Type 2 Diabetes

People with prediabetes are at high risk of developing type 2 diabetes. Their blood glucose levels are higher than normal, but not high enough to be classified as diabetes. 

Acc.to WHO, In 2014 the global prevalence of diabetes * was estimated to be 9% among adults aged 18+ years.  In 2012, an estimated 1.5 million deaths were directly caused by diabetes. More than 80% of diabetes deaths occur in low- and middle-income countries. WHO projects that diabetes will be the 7th leading cause of death in 2030. Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes.

Controlling Diabetes

Disability and premature death are not inevitable consequences of diabetes. Physical activity and dietary interventions, self-management training, ongoing support, and, when necessary, medications can help control the effects of diabetes. By working with a support network and health care providers, a person with diabetes can prevent premature death and disability.

For example,

  • Reducing A1c (a measure of blood glucose control) by one percentage point can reduce the risk of eye, kidney, and nerve diseases by 40%.
  • Controlling blood pressure can reduce the risk of heart disease and stroke by 33%–50% and the risk of eye, kidney, and nerve diseases by 33%.
  • Improving control of low-density lipoprotein (LDL) cholesterol can reduce cardiovascular complications by 20%–50%. Treating diabetic eye disease with laser therapy can reduce the risk of loss of eyesight by 50%–60%.
  • Accessing comprehensive foot care programs can reduce amputation rates by 45%–85%.

 

Global Healthcare Expenditure

Estimated global healthcare expenditures to treat and prevent diabetes and its complications were to total at least US Dollar (USD) 376 billion in 2010. By 2030, this number is projected to exceed some USD 490 billion. Expressed in International Dollars (ID), which is correct for differences in purchasing power, global expenditures on diabetes were at least ID 418 billion in 2010, and at least ID 561 billion in 2030. An average of USD 703 (ID 878) per person were spent on diabetes in 2010 globally.

Expenditures spent on diabetes care are not evenly distributed across age and gender groups. More than three-quarters of the global expenditure in 2010 was used for persons who were between 50 and 80 years of age. Also, more money is expected to be spent on diabetes care for women than for men.

Disparities in healthcare spending

There is a large disparity in healthcare spending on diabetes between regions and countries. More than 80% of the estimated global expenditures on diabetes are made in the world’s economically richest countries, not in the low and middle income countries where over 70% of people with diabetes live.

The United States of America, projected to spend USD 198 billion or 52.7% of global expenditure in 2010, while India, the country with the largest population of people living with diabetes, spent an estimated USD 2.8 billion, or less than 1% of the global total. An estimated average of USD 7,383 per person with diabetes is spent on diabetes-related care in the USA but less than USD10 per person spent in Burundi and Myanmar in 2010.

The financial burden borne by people with diabetes and their families as a result of their disease depends on their economic status and the social insurance policies of their countries. Those living in low income countries pay a larger share of the expenditure because of poorer organized systems of medical care insurance and/or lack of public medical services. In Latin America, for instance, families pay 40-60% of medical care expenditures from their own pockets. In the poorest countries, people with diabetes and their families bear almost the whole cost of the medical care they cannot afford.

Impact on the economy

Diabetes imposes a large economic burden on the individual, national healthcare system and economy. Healthcare expenditures on diabetes were 11.6% of the total healthcare expenditure in the world in 2010. About 80% of the countries are predicted to spend between 5% and 13% of their total healthcare dollars on diabetes.

Besides excess healthcare expenditure, diabetes also imposes large economic burdens in the form of lost productivity and foregone economic growth. The American Diabetes Association estimated that the US economy lost USD 58 billion, equivalent to about half of the direct healthcare expenditure on diabetes in 2007, as a result of lost earnings due to lost work days, restricted activity days, lower productivity at work, mortality and permanent disability caused by diabetes. Such losses are perhaps relatively larger in poorer countries because premature death due to diabetes occurs at much younger ages. The World Health Organization (WHO) predicted net losses in national income from diabetes and cardiovascular disease of ID 557.7 billion in China, ID303.2 billion in the Russian Federation, ID 236.6 billion in India, ID 49.2 billion in Brazil and ID 2.5 billion in Tanzania (2005 ID), between 2005 and 2015.

The largest economic burden, therefore, is the monetary value associated with disability and loss of life as a result of the disease itself and its related complications. This economic burden, however, can be reduced by implementing many inexpensive, easy to use interventions, most of which are cost-effetive or cost-saving, even in the poorest countries. Nonetheless, these interventions are not widely used in low and middle income countries.