Urban population with diabetes poised to increase dramatically

World Diabetes Day programme makes people aware of type 2 diabetes and helps them understand that it is 65 per cent preventable. Death does not have to be painful and premature. The programme also puts pressure on regulatory bodies to provide schools with sports programmes. Bangladesh is densely populated which makes it difficult just to find space for exercise, writes Muhammad Abdul Mazid

The theme for World Diabetes Day 2018 and 2019 is 'The Family and Diabetes'. Diabetes can be expensive for the individual and family. In many countries, the cost of insulin injection and daily monitoring alone can consume half of a family's average disposable income, and regular and affordable access to essential diabetes medicines are out of reach for too many. Improving access to affordable diabetes medicines and care is therefore urgent to avoid increased costs for the individual and family, which impact on health outcomes.

Less than 1 in 4 family-members have access to diabetes education programmes. Family support in diabetes care has been shown to have a substantial effect in improving health outcomes for people with diabetes. It is therefore important that ongoing diabetes self-management education and support be accessible to all people with diabetes and their families to reduce the emotional impact of the disease that can result in a negative quality of life.

Diabetes, a disease no longer associated with affluence, is on the rise across the globe, as reported in 8thedition of the International Diabetes Federation (IDF) Diabetes Atlas 2017. The indicators are significant: millions of people are being destroyed by the current diabetes pandemic which substantiates IDF's mission and rigorous efforts to provide solutions to this worldwide health crisis. Already for some time, diabetes and other noncommunicable diseases (NCDs) that share similar risk factors have represented a primary threat to health and human development. Since the first IDF Diabetes Atlas was published in 2000, the fact that the incidence and prevalence of diabetes continues to rise is self-evident. However, the devastating short- and long-term effects of the disease on the world become more detailed with each new edition of the Atlas. At present, nearly half a billion people live with diabetes. Low and middle income countries carry almost 80 per cent of the diabetes burden. Rapid urbanisation, unhealthy diets and increasingly sedentary lifestyles have resulted in previously unheard higher rates of obesity and diabetes and many countries do not have adequate resources to provide preventive or medical care for their populations.Up-to-date studies and analysis reveal clearly that a robust and more dynamic response not only from different governmental sectors, but also from civil societies, patient organisations, food producers and pharmaceutical manufacturers are needed.

Diabetes is not only a health crisis; it is a global societal catastrophe. Due to its chronic nature, diabetes causes devastating personal suffering and drives families into poverty. Governments worldwide are struggling to meet the cost of diabetes care and the financial burden will continue to expand due to the growing number of people developing diabetes.

Despite the horrifying picture depicted by the new IDF Diabetes Atlas figures, there is a dearth of pragmatic programmes with both knowledge and the expertise to create a brighter future for generations to come.  Awareness on the importance of a healthy diet and physical activity, especially among children and adolescents, and in corporate healthy environments into urban planning has to be raised. Health professionals in primary healthcare should be adequately and appropriately trained about diabetes prevention and care, and provided with necessary screening tools and diabetes medications. As part of the 2030 Agenda for Sustainable Development, Member States of the United Nations have set an ambitious target to reduce premature mortality from NCDs-including diabetes-by one-third; provide access to affordable essential medicines; and achieve universal health coverage, all by 2030.

Going forward, International Diabetes Federation (IDF) is calling for all nations around the globe affected by the diabetes pandemic to work towards the full implementation of Sustainable Development Goals and raise awareness about diabetes since ignorance and misconception remain widespread. This report reminds us that effectively addressing diabetes does not just happen. It is the result of a collective consensus, commitment and public investment in interventions that are affordable, cost-effective and based upon the best available evidence. All should join in ensuring that the findings are utilised and recommendations implemented and adhered to so that the rise in diabetes may be halted.

For those in lower socio-economic groups, who may have limited access to healthy food or places for physical activity, the risk is high and the financial burden of NCDs can be devastating. According to the World Heart Federation, parents can be forced to reduce basic consumption and children can be withdrawn from school to assist in care or to work. In China, expenses from strokes pushed 37 per cent of patients and their families below the poverty line. Research from the International Diabetes Federation in 2009 found that of 2300 people with type 2 diabetes, one in six could not work because of their health, and more than half could not buy all the medicines they needed.

People all over the world, especially in developing countries, have the impression that diabetes is a disease of the rich. That is NOT the case. Diabetes is rising faster in developing countries like Bangladesh. There are many reasons for this, but a key reason is that lifestyles are changing faster in developing countries. This change is related to urbanisation and globalisation. You can't stop it, it is part of civilisation. What is of concern is that with this increased urbanisation people are getting less physical exercise. Even if they want to exercise, there's less space to do that. Workplaces, schools and colleges have few or no facilities for physical activity.

World Diabetes Day programme makes people aware of type 2 diabetes and helps them understand that it is 65 per cent preventable. Death does not have to be painful and premature .The programme also puts pressure on regulatory bodies to provide schools with sports programmes. Bangladesh is densely populated which makes it difficult just to find space for exercise. However, creative solutions can be found. For example, four or five schools can share football grounds.

In developing countries, healthcare is geared towards episodic care. This needs to change to a chronic care model that integrates the healthcare system, the community, and self-management support. The increase in diabetes in Bangladesh is expected to follow global gender patterns, whereby more women than men will live with diabetes. IDF and WHO (World Health Organisation) predict that the number of women in the world with diabetes will double in less than 20 years. In Bangladesh, the number of women with diabetes will grow from the current 2.0 million to 4.0 million by 2025. During the same period, men with diabetes will rise from 1.8 million to 3.4 million. Mirroring trends across the region, the urban population with diabetes in Bangladesh is expected to increase dramatically over the next 20 years. This is due to a combination of urbanisation and migration from rural to urban areas.

Dr Muhammad Abdul Mazid is former Secretary to the Government, former chairman NBR and former Chief coordinator Banhgladesh Diabetic Association.

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