Diabetes: the Developing World's Scourge

The developing world is catching up with the west in unhealthy diet and lack of exercise, with the ominous prospect of a misunderstood and neglected epidemic. The numbers of those afflicted with diabetes increasing alarmingly in every region of the world.

Expressed in International dollars, which correct for differences in purchasing power, according to the World Health Organization, estimated global expenditure on diabetes will be at least ID418 billion this year, rising to at least ID561 billion by 2030. Globally, diabetes will cost an average of ID878 per person afflicted in 2010.

In addition to excess health care expenditure, the affliction imposes large economic burdens in the form of lost productivity, foregone economic growth and disability and loss of life, the WHOI said. In an effort to publicize the risk, the organization is seeking to publicize World Diabetes Day on Nov. 14.

"According to recent estimates of the International Diabetes Federation, not only will the largest increases in prevalence of diabetes occur in developing regions of the world, but it will also affect younger age groups," wrote V. Mohan Deepa of the Madras Diabetes Research Foundation in Chennai, India in the International Journal of Diabetes in Developing Countries. "In the vast majority of low- and middle-income countries, in contrast to the situation in high-income countries, there exist large differences between rural and urban areas in the prevalence of the major risk factors for chronic diseases, including diabetes."

The rising diabetes prevalence, Deepa wrote, "appears to be closely associated with westernization and urbanization, which are associated with sedentary lifestyles and unhealthy energy-dense food choices."

According to the International Diabetes Federation, more than 300 million people suffer from diabetes worldwide, with low- and middle- income countries accounting for four of every five cases. Some 92.4 million suffer from diabetes in China, another 50.8 million in India. To add fuel to the fire, India seems to be at a threshold of an 'outbreak' of obesity, more so in urban Indian cities.

Obese children and adolescents are at an increased risk for the development of early-onset type-2 diabetes mellitus and coronary heart disease. Some 80 percent of type 2 diabetes is preventable by changing diet, increasing physical activity and improving the living environment, according to the World Health Organization. Unfortunately, the trend appears to be inexorably going in the other direction, with increasingly unhealthy diets and diminishing physical exercise.

There is a near global consensus among doctors and scientists that children should be taught that a healthy diet and active lifestyle help to prevent development of the two most prevalent forms of diabetes. Unless preventive measures are taken, obese and insulin resistant children will get afflicted in young adulthood

As Asia Sentinel reported on Sept. 24, an Organization for Economic Cooperation and Development study showed that 29 percent of Chinese are overweight, with 1 percent – 2.6 million people – obese. In Indonesia 26 percent are overweight, 1 percent obese. India reports that 16 percent of its people are overweight, 1 percent obese, G Choudhuri, Professor and Head of the Department of Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences in Lucknow told the Citizen News Service that "The age of onset of diabetes is decreasing, and it is occurring at a younger age these days. Diabetes has a strong genetic component but gets unmasked with disorganized lifestyle and eating habits.

The two important lifestyle issues of concern are increased body weight and lack of exercise. Increasingly, authorities say, urban Indians are leading sedentary lifestyles, with nearly 20 percent of school children overweight or obese and in danger of developing diabetes, according to CNS.

The World Health Organization presented a seriously distressing series of statistics on the disease, pointing out that more than 70 percent of people with diabetes live in low and middle-income countries, varying from 10.2 percent in the Western Pacific to 2.8 percent in Africa.

Fewer than half of those with the affliction are ever even diagnosed, the WHO said. Some 80 percent of type 2 diabetes is preventable by changing diet, increasing physical activity and improving the living environment.

Barry M Popkin, a professor of nutrition at the University of North Carolina, told CNS that "some children, including very young children, snack almost throughout the day. Such findings raise concerns that more children in the world are moving toward a dysfunctional eating patterns –one that can lead to unhealthy weight gain and obesity."

Anoop Misra, head of the Department of Diabetes and Metabolic Diseases at Fortis Hospitals in New Delhi and Noida, blamed trans fatty acids, calling them a "time bomb waiting to explode." Trans Fats are found in fast food products made with hydrogenated oil in an unregulated market.

Initiatives are needed to encourage children and adolescents to eat a nutritious diet and increase physical activity. Schools can be targeted to become harbingers of this change by increasing sports activities in their premises and by monitoring the food/snacks preferences of the students. Some schools have indeed changed the school canteen menu to a tasty health menu and have stopped the sale of cola drinks on the campus. It is worth mentioning here that a single serving of soda or other sweetened soft drink contains between 120 and 200 calories of sugar, equivalent to a man's recommended intake for a full day and exceeding the recommended daily intake for a woman.

According to a study conducted by researchers from the University of California, the booming popularity of sugary soft drinks has led to 6,000 more deaths, 14,000 more cases of heart disease and 130,000 new cases of diabetes in the past 10 years. "We can demonstrate an association between daily consumption of sugared beverages and diabetes risk," researcher Litsa Lambrakos said. "We can then translate this information into estimates of the current diabetes and cardiovascular disease that can be attributed to the rise in consumption of these drinks."

With reporting by Sobha Shukla, the editor of Citizen News Service and director of the CNS Diabetes Media Initiative. Email: shobha@citizen-news.org, website: www.citizen-news.org)