Diabetes: The World at Risk

Diabetes is often thought of as a ‘western’ problem, one linked to the developed world’s overindulgence in fatty foods and chronic lack of physical activity. But with more than 400 million people affected globally, this disease is a global threat

 Which disease causes one death globally every six seconds, or, put another way, five million deaths a year? In India, 78.3 million have the disease, in Mauritius 22 per cent of the population is affected. Yet it is far from only being a disease of the developing world – more than 24,000 people (65 people a day) die before their time from it each year in England and Wales and one in 16 people in the UK has it.

The answer is diabetes and it has emerged as one of the world’s most ubiquitous and chronic illnesses. A lifelong condition that causes a person’s blood sugar level to become too high or too low, diabetes means the body is unable to break down glucose into energy. This is because there is either not enough insulin to move the glucose, or the insulin produced doesn’t work properly (insulin is a hormone that helps to move glucose out of the blood and into cells for energy).

The scale of the problem is daunting: the International Diabetes Federation (IDF) estimated that in 2015 seven countries had more than ten million people with diabetes: China, India, the United States of America; Brazil, the Russian Federation, Mexico and Indonesia. Globally, 422 million people between the ages of 20 and 79 have it, while 47 per cent of diabetes-related deaths occur in those under 60 years of age. By 2040 one person in ten – 642 million people – will, according to IDF projections, have the condition.

For decades, diabetes – specifically, type 2 diabetes – has been lazily dismissed as a disease of the West, and true enough, it does have strong links to lifestyle and obesity. Accordingly, it has been held up as a consequence of much that is wrong with wealthy societies, where people gorge on fast food and sugary drinks. You reap what you sow goes this argument, and diabetes, seen through this prism, can end up crystallising the problems of over-consumption and cheap, sugar-rich food.

The only trouble is that such an over-simplification is grossly misleading: 30 years ago the highest rates of diabetes were indeed to be found in high income countries but in the intervening decades, low and middle income countries have caught up and the incidence there is rising much more quickly. According to the IDF, three quarters of people with type 2 diabetes now live in low or middle income countries.

‘It took the higher income countries 50 years to get to this point, it’s taken low and middle income countries just 15 years,’ says Dr Gojka Roglic of the Department for Management of Non-Communicable Diseases at the World Health Organization. The IDF now says the highest diabetes prevalence can be found in places such as Tokelau, a non-self-governing group of atolls belonging to New Zealand, Nauru, Mauritius, Cook Islands, the Marshall Islands and Palau.

Over those decades, major progress has been made in increasing access to clean water and sanitation, reducing malaria, tuberculosis, polio and the spread of HIV/AIDS. Diabetes has bucked that trend. ‘Diabetes is right up there in the order of magnitude, it kills more people than TB but it doesn’t inspire the fear that epidemic diseases do,’ says Roglic. ‘The problem is that it is not scary enough, it doesn’t threaten the security of the state in a direct way.’