“Beat Diabetes”: A global health commitment for 2016
This year, the World Health Organization selected Diabetes as the priority area of global public health concern for the 2016 World Health Day, an occasion which also coincides with the birthday of the Organization since it was founded in 1948.
In 1980, 108 million adults were living with diabetes. Today, the number has almost quadrupled, rising to 422 million or 8.5 per cent of adults, reflecting a global increase in risk factors such as being overweight or obese.
Emphasis often seem to be more tilted towards adults, WHO however also states that as the frequency of diabetes is rising around the world, studies are showing children are at increasing risk of developing the disease. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves – causing chronic problems and early death.
The Nigerian Medical Association (NMA) in a statement commemorating the world health day noted that more than 1.6 million Nigerians who are living under the scourge of diabetes have constituted a national prevalence of 1.9 per cent who spends up to N53,000 annually for their treatment, and this mainly is an out-of-pocket expenditure.
Also, over 40,000 Nigerians died from the condition in 2015, yet, an estimated one million Nigerians are suspected to have the disease but are yet to be diagnosed and treated, and another estimated 3.85 million people with impaired glucose tolerance- a pre-diabetic condition, NMA revealed.
Diabetes is a Non-Communicable Disease (NCD) directly impacting millions of people globally, mostly in low- and middle-income countries.
United Nations Secretary-General Ban Ki-moon marked World Health Day with a strong call for stepping up global efforts to halt the rise in diabetes and improve the lives of those living with this dangerous but preventable and treatable disease.
“We can limit the spread and impact of diabetes by promoting and adopting healthier lifestyles, especially among young people,” Ki-Moon said in his message on the Day, urging people to eat better and be physically active. He also stressed the need to improve diabetes diagnosis and access to essential medicines such as insulin.
“Governments, healthcare providers, people with diabetes, civil society, food producers, manufacturers, suppliers of medicines and technology, must all contribute to changing the status quo,” Ki-Moon said.
The World Health Organisation in its Global Report on Diabetes stated “Diabetes and its complications bring about substantial economic loss to people with diabetes, their families, health systems and national economies through direct medical costs and loss of work and wages. While the major cost drivers are hospital and outpatient care, a contributing factor is the rise in cost for analogue insulins 1 which are increasingly prescribed despite little evidence that they provide significant advantages over cheaper human insulins,”
Margaret Chan, Director General of WHO also noted “Diabetes is on the rise. No longer a disease of predominantly rich nations, the prevalence of diabetes is steadily increasing everywhere, most markedly in the world’s middle-income countries. Unfortunately, in many settings the lack of effective policies to create supportive environments for healthy lifestyles and the lack of access to quality health care means that the prevention and treatment of diabetes, particularly for people of modest means, are not being pursued. When diabetes is uncontrolled, it has dire consequences for health and well-being.”
“Occurrence of diabetes is rapidly on the rise partly due to increased awareness of the need for medical screening but even more due to the inaction of some people on lifestyle and diet,” says Oretayo Oni, a medical doctor in Lagos.
Oni further explains “prevention is the hallmark of management; moderation in youth beats attempts to treat the ailment at old age, and proper management is based on compliance with clinic visits and medication. Dietary modification also plays a major role in treatment as the former misconception that certain foods should not be eaten has been done away with. Moderation (in very little quantities) is what matters.”
“It has been discovered according to research that the rates at which people die come as a result of self-inflicted none-communicable diseases, like cancer, diabetes and cardiovascular diseases. I will like to put it on record that 30% kidney failure recorded cases came as a result of diabetes,” Babatunde Ipaye is reported to have said.
Diabetes is a chronic, metabolic disease characterised by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. In the past three decades, the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025.
While every country and community is at a different stage in addressing its diabetes challenge, there are a number of activities that could be considered at national and local level on World Health Day 2016 to help achieve its objectives to increase awareness and trigger a set of actions to tackle diabetes.
“Around 100 years after the insulin hormone was discovered, the ‘Global report on diabetes’ shows that essential diabetes medicines and technologies, including insulin needed for treatment are generally available in only 1 in 3 of the world’s poorest countries,” says Etienne Krug, Director of WHO’s Department for the Management of NCDs, Disability, Violence and Injury Prevention.
“Access to insulin is a matter of life or death for many people with diabetes. Improving access to insulin and NCD medicines in general should be a priority.”
Key findings from WHO’s ‘Global report on diabetes’ indicate;
· 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. Higher-than-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’s education to facilitate self-care; and regular screening for early detection and treatment of complications.
The World Health Organisation asserts that Type 1 diabetes cannot be prevented with current knowledge. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids.
Taking a life-course perspective is essential for preventing type 2 diabetes, as it is for many health conditions. Early in life, when eating and physical activity habits are formed and when the long-term regulation of energy balance may be programmed, there is a critical window for intervention to mitigate the risk of obesity and type 2 diabetes later in life. No single policy or intervention can ensure this happens.
It calls for a whole-of-government and whole-of-society approach, in which all sectors systematically consider the health impact of policies in trade, agriculture, finance, transport, education and urban planning – recognizing that health is enhanced or obstructed as a result of policies in these and other areas.
For those who are diagnosed with diabetes, a series of cost-effective interventions can improve their outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control, through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications; and regular screening for damage to the eyes, kidneys and feet, to facilitate early treatment. Diabetes management can be strengthened through the use of standards and protocols.
Caleb Ojewale