A new report from the International Diabetes Federation reveals that cases of diabetes are rising at an alarming rate. One in 10 adults worldwide, 537 million people, now live with the disease which is significantly higher than the 463 million in 2019. Furthermore, this number is predicted to rise to 643 million by 2030 and 783 million by 2045. This trend presents a significant global challenge to the health and well-being of individuals, families, and societies. What are the main causes of diabetes and how can we stop it? We discussed the topic with several global health specialists with expertise in diabetes.
Key Takeaways:
- The number of people with diabetes rose from 463 million in 2019 to 537 million in 2021. Prevalence has been rising more rapidly in low- and middle-income countries, rather than in rich nations
- Diabetes is a major cause of blindness, kidney failure, heart attack, stroke, and lower limb amputation
- Deaths from diabetes increased by 70% globally between 2000 and 2020, with an 80% rise in deaths among males
- Health experts recommend governments focus on healthy lifestyle promotion campaigns to slow down the curve.
Why is diabetes on the rise, especially among the populations of developing countries?
“The rate at which diabetes incidence is increasing continues to be an alarming public health issue, with developing countries witnessing a steady and steep rise in the diagnosis of type 2 diabetes. This trend could be attributed to several concurrent factors resulting mainly from the rapid socio-economic transformation in those countries. Developing countries’ swift shift to urbanization and mechanization feeds into a more sedentary lifestyle. As a consequence of the rapid industrialization of developing economies, air pollution, which is associated with reduced insulin sensitivity and a higher incidence of diabetes, could be a significant risk factor contributing to the rise in diabetes rates. Additionally, the increased access to high-fat and high-salt foods at more affordable prices compared to healthier, local alternatives could significantly contribute to the rise in type 2 diabetes cases.”
“The most common form of diabetes is type 2 diabetes. This type of diabetes occurs gradually as a result of insulin resistance – the inability of the cells of the body to respond to insulin and take sugar from the blood. This causes sugar to accumulate in the blood over time to cause type 2 diabetes. So, we have to look at the main drivers of insulin resistance. Age and family history are risk factors that cannot be changed. Other risk factors that can be avoided are mainly weight gain, lack of physical activity, a poor diet that is rich in sugar, trans-fat or saturated fat and low in fiber, increased alcohol intake, smoking, poor sleep, and lots of emotional stress. People in developing countries are living longer because they are able to fight communicable diseases but the rising levels of urbanization have also led to a change in dietary and physical activity patterns. They also face more emotional stress from work and economic hardship. These factors combine to lead to the rise in diabetes among these populations.”
“Diabetes rates rise where there is easy access to low-grade food at a considerably lower cost than healthy food. Healthy ways to satisfy hunger can easily cost five to 10 times as much as poor quality, unhealthy, and easily available options. White rice (for example) is a significant weekly expense for most families. At five times the price, healthy brown rice is completely unaffordable. Instant noodles quickly and affordably satisfy a child’s hunger and any food store will have them. Poor habits that last a lifetime start with the affordability and convenience of unhealthy food and a lack of understanding around the health risks.”
What are the biggest consequences of the rising trends in diabetes?
“The complications resulting from diabetes present an ongoing challenge both for individuals living with diabetes and the health system overall. Cardiovascular, renal, and cerebrovascular disease, cancer, and infectious diseases are among the prime diabetes-related complications, and they result in a reduced quality of life and increased indirect mortality to those living with the disease. From the health system perspective, this phenomenon would result in significant expenditure on diabetes management therapies and technologies and high operating costs for acute health services. Curbing the rise in type 2 diabetes could help governments to free up funds to invest in implementing policies that focus on preventative measures in diabetes or in other clinical areas that require additional funding.
“The most common consequence of the rising trend in diabetes is an increase in deaths from cardiovascular diseases like stroke, heart attacks, and kidney failure. According to the World Health Organization, approximately 18 million lives are lost to cardiovascular diseases every year. Three-quarters of these deaths occur in developing countries with weak health systems that lack the resources for the timely diagnosis and effective management of cardiovascular diseases. Most of these deaths are preventable when people are able to identify and treat their risk factors for developing cardiovascular diseases including type 2 diabetes on time.”
“Poor eating habits stem from convenience and low cost, as well as poor education and a desire to have a more ‘Western’ lifestyle. Fewer people grow and source food from their environment than ever before. This is a reality exacerbated by dwindling fish stocks and arable land and the impacts of climate change and urbanization. Activity levels decrease for many people, amplifying the negative health impacts of poor diets. Healthcare services are overwhelmed with the treatment of diabetes and its consequences including diabetic retinopathy (the leading cause of preventable blindness). Amputations and vision loss severely limit the capacity of entire families and communities to prosper.”
What action should be taken to slow the curve?
“In collaboration with the clinical community and patient representatives, governments need to develop and implement a national diabetes framework with prevention and management initiatives using evidence-based strategies. Investment in preventative measures that support active lifestyles and better dietary patterns is crucial. Governments also need to ensure that their infrastructure promotes active living and that their policies prioritize the affordability of healthy foods. Regular awareness campaigns emphasizing lifestyle change interventions may help to reduce the incidence of type 2 diabetes. Moreover, improvements in clinical training for healthcare providers, paired with advanced screening and diagnosis models in primary care settings, may help with the early detection of diabetes and allow for quick intervention to slow down its progression. Finally, the introduction of rigorous policies to reduce particulate pollution in developing countries may also reduce the incidence of type 2 diabetes.”
“We need to prioritize the prevention of type 2 diabetes to slow this curve. There is evidence that pre-diabetes, a condition where the blood sugar is high but not high enough to be considered diabetes, is linked with an increased risk of death and an increased risk of having cardiovascular diseases. Pre-diabetes is a direct precursor to type 2 diabetes. Therefore, it is important to prioritize interventions for preventing pre-diabetes to be able to slow this curve. These interventions will aim at slowing down or reversing insulin resistance as populations get older. The key interventions should focus on and combine healthy diet, increased physical activity, and stress management. The US Center for Disease Control and Prevention is championing a diabetes prevention program. This intervention needs to be prioritized in developing countries. Hence, we need to shift our focus and resources to preventing type 2 diabetes while investing in effective treatments for those who already have the condition.”
“While shelves are stocked with abundant cheap low-grade food (sugary drinks, instant noodles, snacks, white rice, etc.) there will be diabetes at increasing rates. Governments and authorities need to move towards heavy regulations, disincentives, and education against poor dietary choices – coinciding with the promotion of healthy (and traditional) produce with incentives to increase production and the affordability of fresh, locally produced options. Health standards should be rigorously applied to food imports to force changes towards healthier eating habits. Money spent on subsidies and the promotion of healthy choices will be more than offset by the savings on the medical and societal costs of diabetes.”
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