There is no country in the world that does not bear some burden from diabetes. The IDF Diabetes Atlas Update for 2012 confirms that cases are increasing everywhere and at an alarming pace. Today, there are an estimated 371 million adults living with diabetes. To put this number into perspective: if all the people with diabetes formed a country, it would be the third most populous country after China and India. Four out of five of the people with diabetes live in low- and middle-income countries, where health systems are struggling to keep pace with the rising burden of non-communicable disease.
Not surprisingly, the countries with the highest numbers of people with diabetes are also those with the largest populations: China, India, the United States, Brazil, and the Russian Federation. The top 10 countries for numbers of people with diabetes account for two-thirds of all cases in the world. All but two of those countries are in active economic development. While large countries have many people with diabetes, the world's smallest nations are by no means exempt. Western Pacific Islands dominate the list of countries with the highest percentage of the population living with diabetes. In such countries, diabetes is almost the norm and not the exception, with more than one quarter of adults over 20 living with the disease.
It is not just cases of diabetes that are on the rise; deaths due to diabetes are also increasing. New evidence informs estimates that there were 4.8 million deaths in adults attributable to diabetes in 2012. That is the equivalent of one death every 7 s. Most of those deaths occurred in middle-income countries where the mortality rate due to diabetes is also higher than in high-income countries. The difference in rates can be explained partially by the fact that there is an overall higher death rate in low- and middle-income countries; but it may also reflect health systems that are not equipped to respond effectively to the diabetes epidemic.
The tip of the iceberg
The new Atlas estimates also show a high proportion of undiagnosed diabetes. Up to half of all cases in the world have not been diagnosed, representing approximately 187 million people. Type 2 diabetes can progress for many years without showing any symptoms, and often when symptoms do appear, they are not immediately recognized as being due to diabetes. During this time, high levels of blood glucose, blood pressure and cholesterol continue to damage the body unchecked, provoking complications. Often, it is not until a complication has already developed that diabetes is diagnosed. This delay is a serious problem for the individual who must deal with the disabling consequences. Moreover, diabetes that has progressed to complications is more difficult and more expensive to manage, placing a serious extra burden on health systems and economies, than diabetes that is detected early.
An estimated USD 471 billion was spent globally in 2012 on healthcare for the treatment and management of diabetes. Some of this spending represents an important investment in care that is essential to managing the disease. Much of it, however, results from unmanaged diabetes and the high costs involved in treating complications – spending that could have been prevented. So the true cost of diabetes is higher than USD 471 billion, which does not include money spent by people with diabetes on travelling to their care centre, lost wages from disability or the expenses the family incurs to support a person affected by the disease. In low- and middle-income countries, a disproportionate amount of this cost is paid out-of-pocket by the person living with diabetes. With major complications of diabetes, such as stroke, often affecting the wage earners of the family, the wider economic impact of diabetes becomes even greater. The substantial expense diabetes can impose on a household means that in some situations, having the disease can put people at risk of poverty.
Our most valuable resource under threat
Evidence also indicates that type 2 diabetes is affecting people at younger ages than ever before. The majority of people with diabetes are under the age of 60. Studies from countries in the rapidly developing Middle East show that half of adults over 45 in some regions have diabetes. New studies have shown that younger people who develop type 2 diabetes progress to complications at a faster pace and are at a higher risk of dying early from the disease than older people with diabetes. In parallel, up to half of all deaths due to diabetes are occurring in people under the age of 60. This evidence dispels the myth that diabetes is only a disease of the elderly.
Finding the figures
Describing a disease and its impact starts with measuring its magnitude. The Atlas project routinely gathers information published in medical journals and reports describing the prevalence of diabetes in countries, regions and cities. The evidence from those publications is then pulled together and systematically reviewed to generate the estimates presented in the IDF Diabetes Atlas. These estimates are the keystone for diabetes advocacy and they can be a powerful tool to motivate change from governments. In order to maintain the urgency needed to drive that change, the IDF Diabetes Atlas project will produce a new Atlas every two years, and an update of the estimates in the years in between.
The rapid pace of the epidemic has obvious implications for the individuals and families affected on a daily basis. But it is also affecting health systems and economies. The evidence for urgent action on diabetes continues to be overwhelming. The chronic and progressive nature of the disease ensures that unless prevention happens early and effectively – without the necessary prevention, treatment and attention – the epidemic is set to overwhelm at an ever-increasing pace all countries that have not yet committed to meeting diabetes head-on.
☆This article is published thanks to the permission of Diabetes Voice, the quarterly magazine of IDF.
© 2012 Published by Elsevier Inc.