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United Nations Resolution 61/225:
World Diabetes Day
www.worlddiabetesday.org
“For the first time, a non-infectious disease
has been seen as posing as serious a global health
threat as infectious epidemics such as HIV/AIDS.”
© Courtesy of Children At Risk Foundation (CARF), www.carfweb.net
United Nations Resolution 61/225:
World Diabetes Day
On 20 December 2006, the United Nations General Assembly passed Resolution 61/225.
This landmark Resolution recognizes diabetes as a chronic, debilitating and costly disease
associated with major complications that pose severe risks for families, countries and the
entire world. It designates 14 November, the current World Diabetes Day, as a United Nations
Day to be observed every year beginning in 2007.
Governments have acknowledged that diabetes is increasing at epidemic rates and is
affecting all countries. For the first time, a non-infectious disease has been seen as posing as
serious a global health threat as infectious epidemics such as HIV/AIDS.
The World Diabetes Day Resolution was the first goal of an ambitious campaign led by the
International Diabetes Federation. Launched in June 2006, the Unite for Diabetes campaign
aimed to raise awareness of diabetes and secure a United Nations Resolution. Within six
months, with the strong backing of the global diabetes community, the Resolution was
passed. Its passage through the diplomatic process was initiated and facilitated by the
People’s Republic of Bangladesh. It was brought to the floor of the General Assembly by the
Republic of South Africa on behalf of the Group of 771 and China.
It was especially significant that Bangladesh, one of the poorest countries in the world, was
the sponsoring country. Bangladesh recognized that the double burden of infectious disease
and diabetes threatened to subvert the gains of economic development in the developing
world, which already shoulders 70% of the diabetes burden.
The need to slow the growing diabetes burden inspired the push for a UN resolution on
diabetes. The campaign brought together the largest ever coalition of diabetes representative
organizations, all coming together under the Unite for Diabetes banner. The coalition included
over 195 IDF member associations from more than 155 countries, the majority of the world’s
global scientific and professional diabetes societies, industry partners, as well as many
charitable foundations and service organizations. The campaign was a truly global effort that
involved a top-down political approach and a grass-roots awareness movement on behalf of
the 246 million people living with diabetes and the many millions more at risk.
1
The G-77 is the largest intergovernmental organization of developing states in the United Nations. Its 130 members form a powerful voting bloc.
1
The World Diabetes Day Resolution
The Resolution’s passage is a major achievement, but is just the first step in the struggle to
reverse the diabetes epidemic and save lives. The United Nations has shown its commitment
to that struggle by throwing its support behind World Diabetes Day and encouraging nations
to act now.
The Resolution invites all Member States, relevant UN organizations, and civil society
to observe World Diabetes Day on 14 November, in order to raise public awareness on
prevention and the care of diabetes through education and the mass media.
Significantly, Resolution 61/225 establishes the global agenda for the coming fight against the
diabetes pandemic by encouraging all nations to develop national policies for the prevention,
care and treatment of diabetes. It asks for nations to do this in line with the sustainable
development of their healthcare systems, taking into account internationally agreed
development goals, including the Millennium Development Goals.
Implementing the Resolution
The full impact of the World Diabetes Day Resolution will take many years to unfold. There
are two main challenges that need to be addressed: the prevention of diabetes itself, and
the prevention of complications in those affected by diabetes − now numbering almost 250
million or roughly 6% of the world’s adult population. Different strategies and responses will
be required. The Resolution, by calling on UN Member States to develop national policies for
the prevention of diabetes, underscores the need to stem the tide of new cases to prevent the
world’s healthcare systems from being overwhelmed.
The development of national policies for the prevention of diabetes will create many
challenges, not the least of which will be to understand better the environmental and societal
factors that are driving what has been called the epidemic of the 21st century. Individual
lifestyle choices and changes in the living environment beyond the control of the individual
will need to be scientifically evaluated. Simplistic responses (“no-one told you to over-eat
and not exercise”) do little to solve the problem. It will require increased public awareness
of the prevention of type 2 diabetes and the responsibility that individuals and families
over the lifestyle choices they make. However, strategies must be developed to address the
negative changes to the living environment that are behind the pandemic. These strategies
will demand whole-of-government actions, not just the actions of agencies responsible for
healthcare.
The reality is that there will be no automatic increase in funds for diabetes for either
prevention or treatment in the short term. The International Diabetes Federation recognizes
that the diabetes world will need to be part of the solution and not simply be regarded as the
problem. People with diabetes, when educated in self-care and empowered, are critical to the
success of any programme. The diabetes world demonstrated how it was able to Unite for
Diabetes to achieve the Resolution.
2
Through this unity, the diabetes world could bring many assets to future partnerships for the
prevention and care of diabetes with inter-sectoral government agencies, UN organizations,
non-governmental organizations, civil society and industry.
One of the ways the International Diabetes Federation would facilitate this, is by creating a
Global Diabetes Fund to attract, manage, and disburse additional funds for the prevention
and care of diabetes through private public partnerships. The Global Diabetes Fund would be
closely modelled on the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Diabetes is one of the world’s most important causes of expenditure, mortality, disability and
lost economic growth. There are simple, cheap treatments that can help prevent these losses,
many of which will actually save money in countries, rich and poor. The economic returns
of improved diabetes prevention and treatment are relatively higher in the world’s low- and
middle-income countries, where the majority of people with diabetes live but where few of
them are treated cost-effectively.2
For most of the world, the solutions to the spiralling diabetes pandemic will involve
improving access to proven but low-cost therapies, especially in low-income countries that
face major environmental and social issues as well as poverty. Developing countries will need
to be supported by international and national partnerships but will ultimately need to take
ownership and leadership of the solutions that they will need to implement. Country-specific
data on the burden of diabetes are required urgently, together with a clear understanding
of the extent of national policies for the prevention and care of diabetes. In developing
countries, many vertical streams of excellence in delivering diabetes care exist. Yet all too
often they work in isolation. Horizontal integration of their efforts would greatly enhance their
effectiveness.
The World Bank recently identified seven diabetes treatments that would actually save money
if prescribed, even in the poorest regions of the world, and five more that would be highly
cost-effective (in the poorest regions, between USD 60 and 660 per life year saved). It is
tragic that these treatments are not used more. This situation presents an opportunity. The
International Diabetes Federation believes that the fastest and most efficient way to improve
health in poor and middle-income countries is to provide cheap, simple, proven treatments
to people threatened with diabetes and cardiovascular disease. Doing so will help strengthen
primary care, stabilize families, liberate women to seek greater educational and employment
opportunities, and improve standards of living.
The International Diabetes Federation commits itself to developing programmes for the
prevention and treatment of diabetes with partners such as governments, UN organizations
(the World Health Organization, Food and Agricultural Organization and UNICEF etc.), World
Bank, non-governmental organizations, civil society, philanthropic and service organizations,
as well as industry.
2
Diabetes Atlas 3rd Edition, International Diabetes Federation, 2006. pg. 247
3
The General Assembly,
Recalling the 2005 World Summit Outcome3 and the United Nations
Millennium Declaration,4 as well as the outcomes of the major United
Nations conferences and summits in the economic, social and related
fields, in particular the health-related development goals set out
therein, and its resolutions 58/3 of 27th October 2003, 60/35 of 30th
November 2005 and 60/265 of 30 June 2006,
Recognizing that strengthening public-health and health-care delivery
systems is critical to achieving internationally agreed development
goals, including the Millennium Development Goals,
Recognizing also that diabetes is a chronic, debilitating and costly
disease associated with severe complications, which poses severe
risks for families, Member States and the entire world and serious
challenges to the achievement of internationally agreed development
goals, including the Millennium Development Goals,
Recalling World Health Assembly resolutions WHA42.36 of 19th May
1989 on the prevention and control of diabetes mellitus5 and
WHA57.17 of 22th May 2004 on a global strategy on diet, physical
activity and health,6
Welcoming the fact that the International Diabetes Federation
has been observing 14th November as World Diabetes Day at a
global level since 1991, with co-sponsorship of the World Health
Organization,
3
See resolution 60/1.
4
See resolution 55/2. 06-50787
4
Recognizing the urgent need to pursue multilateral efforts to promote
and improve human health, and provide access to treatment and
health-care education,
1. Decides to designate 14th November, the current World
Diabetes Day, as a United Nations Day, to be observed every
year beginning in 2007;
2. Invites all Member States, relevant organizations of the
United Nations system and other international organizations, as
well as civil society, including non-governmental organizations and
the private sector, to observe World Diabetes Day in an appropriate
manner, in order to raise public awareness of diabetes and related
complications, as well as its prevention and care, including through
education and the mass media;
3. Encourages Member States to develop national policies for
the prevention, treatment and care of diabetes in line with the
sustainable development of their health-care systems, taking into
account the internationally agreed development goals, including the
Millennium Development Goals;
4. Requests the Secretary-General to bring the present resolution to
the attention of all Member States and organizations of the United
Nations system.
83rd plenary meeting
20 December 2006
5
See World Health Organization, Forty-second World Health Assembly, Geneva, 8–19 May 1989,
Resolutions and Decisions, Annexes (WHA42/1989/REC/1).
6
Ibid., Fifty-seventh World Health Assembly, Geneva, 17–22 May 2004,
Resolutions and Decisions, Annexes (WHA57/2004/REC/1). 06-50787
5
World Diabetes Day
United Nations Resolution 61/225 welcomes “the fact that the International Diabetes
Federation has been observing 14 November as World Diabetes Day at a global level since
1991, with co-sponsorship of the World Health Organization” and designates “14 November,
the current World Diabetes Day, as a United Nations Day, to be observed every year beginning
in 2007.”
World Diabetes Day is the primary awareness campaign of the diabetes world. It was
introduced by the International Diabetes Federation (IDF) and the World Health Organization
(WHO) in 1991, in response to concern over the escalating incidence of diabetes around the
world.
World Diabetes Day is celebrated every year on 14 November. The date was chosen because
it is the birthday of Frederick Banting who, along with Charles Best, first conceived the idea
which led to the discovery of insulin in 1921. While many events take place on or around the
day itself, themed campaigning is spread over the whole year.
World Diabetes Day is celebrated worldwide by more than 195 member associations of the
International Diabetes Federation in over 155 countries, as well as by other associations and
organizations, healthcare professionals, people with diabetes and their families.
The campaign aims to inform the public of the causes, symptoms, complications and
treatment associated with the condition. World Diabetes Day brings together millions of
people all over the world to raise awareness of diabetes, including children and adults
with and without diabetes, healthcare professionals, decision makers and the media. The
campaign serves as an important reminder that the incidence and prevalence of diabetes is
increasing worldwide.
Each year World Diabetes Day is centred on a theme related to diabetes. Topics covered
in the past have included diabetes and human rights, diabetes and lifestyle, and the costs
of diabetes. In recent years, particular attention has been paid to diabetes complications
affecting the heart, eyes, kidneys, and feet. Recent themes include:
2004: Diabetes and obesity
2005: Diabetes and foot care
2006: Diabetes in the disadvantaged and the vulnerable
6
“World Diabetes Day is the
primary awareness campaign
of the diabetes world.”
© CE/J. Silva Rodrigues
In 2007 and 2008, World Diabetes Day focuses on promoting the UN Resolution and raising
awareness of the impact of diabetes on the lives of children and adolescents worldwide.
Diabetes is one of the most common chronic diseases of childhood. It can strike children at
any age, including pre-school children and even toddlers. Yet diabetes in children is often
diagnosed late, when the child has diabetic ketoacidosis, or can be misdiagnosed completely.
As a consequence, many children die of diabetes, particularly in low and middle-income
countries. World Diabetes Day will aim to raise awareness of the rising prevalence of both
type 1 and type 2 diabetes in this age-group, and emphasize the importance of early diagnosis
and education to reduce complications and save lives.
The UN Resolution makes World Diabetes Day stronger than ever and provides the
opportunity for a significant increase in the visibility of the campaign and an increase in
government and media participation on or around November 14. The Resolution will ensure
even greater reach for awareness-raising activities throughout the diabetes world. To mark
the strong link between World Diabetes Day and the Unite for Diabetes campaign, the blue
diabetes circle has been officially adopted as the logo for World Diabetes Day. The blue
circle is a simple icon that can be easily adapted and widely adopted. The significance of the
symbol is overwhelmingly positive. Across cultures the circle symbolizes life and health. Most
significantly, the circle signifies unity. The global diabetes community must come together to
effectively combat the diabetes epidemic.
Visit www.worlddiabetesday.org for more information.
7
10 Misconceptions about Diabetes
1. Diabetes is not a killer disease – False!
In fact, diabetes is a global killer, rivalling HIV/AIDS in its deadly reach. The disease kills some
3.8 million people a year. Every 10 seconds a person dies from diabetes-related causes.
2. Diabetes only affects rich countries – False!
Diabetes hits all populations, regardless of income. It is becoming increasingly common.
More than 240 million people worldwide now have diabetes. This will grow to more than
380 million by 2025. In many countries in Asia, the Middle East, Oceania and the Caribbean,
diabetes affects 12-20% of the population. In 2025, 80% of all cases of diabetes will be in low-
and middle-income countries.
3. Diabetes is heavily funded globally – False!
Official Overseas Development Aid to the health sector in 2002 reached USD 2.9 billion, of
which a mere 0.1% went to fund ALL non-communicable chronic diseases (NCDs). Most of
the USD 2.9 billion went to support HIV/AIDS. Despite diabetes having a deadly global impact
comparable to HIV/AIDS, it had to share the tiny 0.1% of the total NCD funding.
In addition, the World Bank gave USD 4.2 billion in loans for health, population and nutrition
between 1997 and 2002. Only 2.5% of the USD 4.2 billion went to chronic diseases.
4. Diabetes care is not costly – False!
Diabetes care is costly and has the potential to cripple any healthcare system. The economic
opportunities that the United Nations wants to create for developing countries through
the Millennium Development Goals will be greatly undermined by the economic impact of
diabetes in low- and middle-income countries.
5. Diabetes only affects old people – False!
In reality, diabetes affects all age groups. Currently, an estimated 246 million people between
the ages of 20 and 79 will have diabetes. In developing countries diabetes affects at least 80
million people between ages 40-59.
86. Diabetes predominantly affects men – False!
In fact, diabetes is rising in both men and women, and affects slightly more women than
men. It is also increasing dramatically among youth and threatening to decimate indigenous
populations.
7. Diabetes is the result of unhealthy “lifestyles” – False!
The reality is that the poor and children have limited choices when it comes to living
conditions, diet and education.
8. Diabetes cannot be prevented – False!
While it is true that type 1 diabetes is not preventable, up to 80% of type 2 diabetes is
preventable by a healthy diet, increasing physical activity and promoting a healthy lifestyle.
9. Diabetes prevention is too expensive – False!
Many inexpensive and cost-effective interventions exist. Proven strategies for improving the
living environment, changing diet and increasing physical activity can reverse the pandemic.
10. We all have to die of something – True but. . .
Death is of course inevitable but it does not need to be slow, painful or premature. Diabetes
causes 3.8 million deaths globally. With awareness, prevention and appropriate care, many of
these deaths can be prevented.
References
The idea for ‘10 misconceptions about diabetes’ is based on the World Health Organization’s
global report: ‘Preventing chronic diseases: a vital investment’, which presents 10 common
misunderstandings about chronic diseases. The data comes from various sources, including:
Roglic G et al: The Burden of Mortality Attributable to Diabetes: Realistic estimates for the
year 2000. Diabetes Care 28: 2130-2135. The Diabetes Atlas 3rd Edition, International Diabetes
Federation, 2006. Yach D et al: The global burden of chronic diseases. JAMA 2004).
9The International Diabetes Federation
The International Diabetes Federation (IDF) is the global advocate for more the 246 million
people with diabetes worldwide as well as their families and healthcare providers. It represents
more than 195 diabetes associations in over 155 countries. IDF is a non-governmental organi-
zation in official relations with the World Health Organization and is associated with the
Department of Public Information of the United Nations.
The mission of IDF is “to promote diabetes care, prevention and a cure worldwide”,
a statement of intent that addresses the challenges facing the global diabetes community
in the 21st century.
➜ Care: the core activity of IDF remains the promotion of the best possible care for anyone who
lives with diabetes. IDF works in close collaboration with its member associations to increase
access to and improve the quality of care that is currently available for people with diabetes.
➜ Prevention: prevention is the only realistic way to slow the rate at which diabetes is
increasing and to lessen the impact of diabetes upon the quality of life of those currently
living with the disease. IDF encourages the implementation of prevention programmes to
reduce the risk of diabetes for the general population and to reduce the risk of
complications in people living with diabetes.
➜ Cure: while IDF does not support research directly, through awareness and education it
encourages the efforts of those who seek to further understand the causes of diabetes and
of those whose aim it is to find a cure.
➜ IDF activities include advocacy and lobbying work, education for people with diabetes and
their healthcare providers, public awareness and health improvement campaigns, as well
as the promotion of the free exchange of diabetes knowledge. A few examples include:
➜ World Diabetes Day, the primary awareness campaign of the diabetes world, now a UN Day;
➜ United Nations Resolution 61/225: World Diabetes Day, as a result of the successful Unite
for Diabetes campaign;
➜ IDF Task Forces’ efforts on specific issues such as access to insulin, association
development and the economics of diabetes care;
➜ IDF serial and non-serial publications, including the Diabetes Atlas and Diabetes Voice;
➜ The Education Foundation, which supports a number of education and research
fellowships and programmes.
➜ IDF online (www.idf.org), a source of up-to-date information about IDF and its activities.
➜ IDF World Diabetes Congresses, which provide a unique and international forum to discuss
a wide variety of diabetes-related topics.
10“Diabetes is a global epidemic
with devastating human, social
and economic consequences.”
© Jesper Westley
Diabetes: a global threat
The United Nations Resolution on diabetes was necessary because diabetes is fast emerging
as one of the most serious health problems of our time. Diabetes is a global epidemic with
devastating human, social and economic consequences. The disease claims as many lives
per year as HIV/AIDS and places a severe burden on healthcare systems and economies
everywhere, with the heaviest burden falling on low- and middle-income countries. Yet
awareness of the global scale of the diabetes threat remains pitifully low.
Diabetes prevalence
It is estimated that 246 million people worldwide have diabetes, representing roughly 6% of
the adult population (20-79 age group). The number is expected to reach some 380 million by
2025, representing 7.1% of the adult population.
The Western Pacific Region with 67 million and the European Region with 53 million have the
highest number of people with diabetes in 2007. However, in terms of prevalence, it is the
Eastern Mediterranean and Middle East Region that has the highest rate (9.2%) followed by
the North American Region (8.4%).
By 2025 the diabetes prevalence of the South and Central America Region is expected to be
nearly as high (9.3%) as that of the North American Region (9.7%). The Western Pacific Region
will continue to have the highest number of people with diabetes, with some 100 million,
representing an almost 50% increase from 2007.
Impaired Glucose Tolerance
People with impaired glucose tolerance (IGT) have a significant risk of developing type 2
diabetes. It is estimated that approximately 308 million, or 7.5% in the 20-79 age group, have
IGT. More than 80% of these people live in developing countries. By 2025 the number of
people with IGT is projected to increase to 418 million, or 8.1% of the adult population.
The Western Pacific Region has the greatest number of people with IGT, with some 112
million, although the European Region has the highest prevalence rate with 9.1% of the adult
population affected by IGT. By 2025, the greatest increase in the number of people with IGT
will occur in Africa and in the Eastern Mediterranean and Middle East Region.
11Diabetes in developing countries
In many developing countries, the burden of diabetes care threatens to undermine the
benefits of improving standards of living, education and economic growth. It is estimated
that almost 80% of the 246 million people with diabetes live in developing countries. Seven
out of the ten countries with the highest number of people with diabetes are already in the
developing world. Within the next 20 years, the largest increases will take place in the regions
dominated by developing economies if preventive measures are not taken. These countries
will have to bear the brunt of the diabetes burden. Often, policy decision makers are not
aware of the public health challenge at their door.
Each year, some 3.8 million adults die from diabetes-related causes. The burden is particularly
harsh in low- and middle-income countries, where many children with type 1 diabetes die
because they lack access to life-saving insulin and where many do not receive the education
and care required to delay and prevent complications.
Diabetes in younger age groups
In the past, type 2 diabetes was often thought of as a disease of the elderly. Today, the world
is witnessing a rising trend of type 2 diabetes in younger age groups. Diabetes has shifted
down a generation and is affecting many during their economically most productive years.
Whereas the largest numbers of people with diabetes are in the 60-79 age group in Europe,
in other regions such as South and Central America, South-East Asia and the Western Pacific,
the largest number of people with diabetes are in the 40-59 age group. The 40-59 age group
currently has the greatest number of people with diabetes (113 million), representing 46% of
the total number. This will place an additional burden on health budgets and on society as a
whole, particularly because it is the case that the risks of diabetes complications increase over
time.
Type 1 diabetes in the young
The incidence of type 1 diabetes in the young is increasing in many countries. The overall
annual increase is estimated at around 3%. Some 70,000 children under the age of 14 develop
type 1 diabetes every year.
Of the estimated total of approximately 440,000 cases of type 1 diabetes in children under
14, more than 25% come from the South-East Asian Region and more than 20% from the
European Region. Finland, Sweden and Norway have the highest incidence rates for type 1
diabetes in children.
12Type 2 diabetes in the young
Type 2 diabetes in children and adolescents is also on the rise and affects children in both
developed and developing countries. While not enough studies have been carried out in this
area, it is now recognized that type 2 diabetes in children is becoming a global public health
issue with potentially serious health outcomes.
The risk of type 2 diabetes in children is clearly linked to an increasing prevalence of obesity,
which in turn is associated with changing dietary and lifestyle patterns. The change to a
westernized lifestyle characterized by, among other things, poor diet and lack of exercise is
fast occurring in both developed and developing countries, where it is most common in urban
areas.
Studies have shown that youth with type 2 diabetes run the risk of developing micro- and
macrovascular complications at a relatively early age. This places and, without action, will
increasingly place a significant burden on health budgets and society as a whole.
The economic impact of diabetes
Global health expenditures to treat and prevent diabetes and its complications amount to
hundreds of billions of dollars every year. World treatment costs are growing more quickly
than world population. However, the larger costs of diabetes arise from premature death
and disability caused by its preventable complications, including heart, kidney, eye and foot
disease.
More than 80% of expenditure for medical care for diabetes are made in the world’s
economically richest countries. However, in the world’s poorest countries, where 80% of
people with diabetes will soon live, not enough is spent to provide even the least expensive
lifesaving diabetes drugs.
References:
All data are taken from Diabetes Atlas, 3rd edition, International Diabetes Federation, 2006.
The following maps and tables can be downloaded from the IDF website
from the following link: www.eatlas.idf.org/media
At a glance
2007 2025
Total world population (billions) 6.6 7.9
Adult population (age 20-79, billions) 4.1 5.2
WORLD DIABETES AND IGT (20-79 age group)
Diabetes
Comparative prevalence (%) 6.0 7.3
Number of people with diabetes (millions) 246 380
IGT
Comparative prevalence (%) 7.5 8.0
Number of people with IGT (millions) 308 418
1314
15
Top 10 countries in prevalence of diabetes*
(20-79 age group)
2007 2025
Country Prevalence (%) Country Prevalence (%)
1 Nauru 30.7 1 Nauru 32.3
2 United Arab Emirates 19.5 2 United Arab Emirates 21.9
3 Saudi Arabia 16.7 3 Saudi Arabia 18.4
4 Bahrain 15.2 4 Bahrain 17.0
5 Kuwait 14.4 5 Kuwait 16.4
6 Oman 13.1 6 Tonga 15.2
7 Tonga 12.9 7 Oman 14.7
8 Mauritius 11.1 8 Mauritius 13.4
9 Egypt 11.0 9 Egypt 13.4
10 Mexico 10.6 10 Mexico 12.4
Top 10 countries in number of people with diabetes
(20-79 age group)
2007 2025
Country Persons (millions) Country Persons (millions)
1 India 40.9 1 India 69.9
2 China, People’s Republic of 39.8 2 China, People’s Republic of 59.3
3 USA 19.2 3 USA 25.4
4 Russia 9.6 4 Brazil 17.6
5 Germany 7.4 5 Pakistan 11.5
6 Japan 7.0 6 Mexico 10.8
7 Pakistan 6.9 7 Russia 10.3
8 Brazil 6.9 8 Germany 8.1
9 Mexico 6.1 9 Egypt 7.6
10 Egypt 4.4 10 Bangladesh 7.4
1617
18
19
The diabetes epidemic: facts
➜ Diabetes affects 246 million people worldwide and is expected to affect some 380 million
by 2025.
➜ Each year another 7 million people develop diabetes.
➜ Each year, 3.8 million deaths are linked directly to diabetes-related causes including
cardiovascular disease made worse by diabetes-related lipid disorders and hypertension.
➜ Every 10 seconds a person dies from diabetes-related causes.
➜ Every 10 seconds two people develop diabetes.
➜ In many countries in Asia, the Middle East, Oceania and the Caribbean, diabetes affects
12 to 20% of the adult population.
➜ Seven of the 10 countries with the highest number of people living with diabetes are in
the developing world.
➜ In 2025, 80% of all diabetes cases will be in low and middle-income countries.
➜ Just under half of all people with diabetes are aged between 40 and 59. More than 70%
of them live in developing countries.
➜ India has the largest diabetes population in the world with an estimated 41 million people,
amounting to 6% of the adult population.
➜ In China, where 4.3% of the population is affected by diabetes, the number of people with
this condition is expected to exceed 50 million within the next 20 years.
➜ Type 1 diabetes, which predominately affects youth, is rising alarmingly worldwide,
at a rate of 3% per year.
➜ Some 70,000 children aged 14 and under develop type 1 diabetes annually.
➜ An increasing number of children are developing type 2 diabetes, in both developed and
developing nations.
➜ Type 2 diabetes has been reported in children as young as eight.
➜ Reports reveal the existence of type 2 diabetes in child populations previously thought
not to be at risk.
➜ In Japan, the prevalence of type 2 diabetes amongst junior high school children has
doubled from 7.3 per 100,000 in 1976-80 to 13.9 per 100,000 in 1991-95,
with type 2 diabetes now outnumbering type 1 diabetes in that country.
References:
All epidemiologic data are drawn from the Diabetes Atlas, third edition,
International Diabetes Federation 2006
20The Economics of Diabetes: Human and Social Effects
The global diabetes epidemic has devastating personal and social effects, far greater than
most people imagine. Surprisingly, the highest costs of diabetes are not the hundreds of
billions spent on complications that could have been prevented, although these expenditures
are large, but the suffering imposed on families (death, disability and economic stress) and
the resulting large annual losses in economic growth that harm everyone. Diabetes harms all
people in society, not just those who live with diabetes.
From an economic point of view, these effects are tragic because proven, low-cost treatments
are available to prevent most of them. Even in the poorest countries, many of these
treatments would actually save medical care expenditures.
Death and disability
Diabetes is expected to cause 3.8 million deaths worldwide in 2007, roughly 6% of total
world mortality, about the same as HIV/AIDS and malaria combined. Using World Health
Organization (WHO) figures on years of life lost per person dying of diabetes, this translates
into more than 25 million years of lost life each year.
The International Diabetes Federation (IDF) estimates that the equivalent of an additional 23
million years of life are lost each year to the disability and reduced quality of life caused by
diabetes complications.
Losses to mortality and disability are particularly high in poor and middle-income countries,
where people with diabetes are unlikely to get the treatments that are proven to prevent the
disease’s killing and disabling complications. For example, in sub-Saharan Africa mortality
from diabetes is four times higher than the world average.
In these locations, children with type 1 diabetes often die because governments do not
ensure that insulin is available and affordable. Instead, many governments tax insulin at
their borders, and prevent low-cost generic insulin from being sold. A recent comparison of
three otherwise similar African countries showed the consequences. In Zambia, which has a
program for insulin management, a person requiring insulin for survival can expect to live an
average of 11 years. In Mali, the same person can expect to live for only 30 months, while in
Mozambique that person will be dead within a year.
Needless deaths in children are tragic and affecting. Statistically, however, diabetes causes
nearly all its death and disability in adults. As a result, many children’s lives are adversely
affected by a diabetes-related death or disability in the family. This can mean that children
must abandon education to supplement the household income or help care for an ailing
relative. The economic impact of diabetes on the family can leave no money to pay for
children’s medicine and schooling.
21Family economic stress from diabetes
In the poorest countries, people living with diabetes and their families bear almost the entire
cost of whatever medical care they can afford. In India, for example, the poorest people with
diabetes spend an average of 25% of their income on private care. The most that they can pay
for are treatments that keep them alive by blunting the highest, quickly fatal levels of blood
sugar.
Where average incomes are higher, as in Latin America and the Caribbean, families still pay
40-60% of diabetes care costs out of their own pockets, which strictly limits the amount of
care that they can get. Blood sugar regulating drugs alone are reported to account for about
half of all spending. Little or no money is available to pay for the aspirin, ACEI-inhibitors,
statins, and other cheap generic drugs that could prevent renal failure, heart attacks, strokes,
and amputations.
IDF’s new estimates of national diabetes-care spending for 2007 include USD 6 per person
with diabetes in Burundi, USD 10 in Tajikistan, USD 78 in Guyana, and USD 48 in Haiti. These
amounts cannot even cover the annual wholesale price of a generic oral agent capable of
preventing acute, life-threatening high-blood sugar.
22Lost economic growth and development
The devastating effects of diabetes on families translate into significant losses for every individual
in society. The mechanisms are many: loss of investments in trained labour; increased taxation
(in all its forms) for medical care and support of the disabled; the economic failure of family
units and small businesses; withdrawals of children from education (especially girls) to care for
ailing relatives; AIDS, tuberculosis, crime and other adverse consequences of destitution; and the
general loss of the hope and self-reliance that ultimately drive all economic growth.
Considering mainly the effects of premature mortality, WHO estimates that (between 2005 and
2014) diabetes, heart disease and stroke combined will cost:
➜ $555.7 billion in lost national income in China,
➜ $303.2 billion in the Russian Federation;
➜ $336.6 billion in India;
➜ $49.2 billion in Brazil
➜ $2.5 billion even in a very poor country like Tanzania.
Much of the heart disease and stroke in these estimates is linked to diabetes.
If nothing is done, diabetes threatens to subvert the gains of economic advancement globally.
Accounting for disability, the opportunity costs of care-giving and other factors might triple
these WHO figures. Government budgets worldwide will face the immense strain of diabetes
care on disability payments, pensions, social and medical service costs, and revenue.
Furthermore, private health insurers and employers will face the spiralling costs of treating
more and more people with diabetes.
Because diabetes is increasing faster in the world’s developing economies than in its
developed ones, it is the developing world that will bear the brunt of lost economic growth.
The economic opportunities that the United Nations wants to create for developing countries
with its Millennium Development Goals will be greatly undermined by diabetes if treatments
to prevent its complications are not used.
Better treatment can save money everywhere
The costly and fatal effects of diabetes arise largely from its complications, especially heart
disease, stroke, amputation and kidney failure. These can be prevented or long-delayed by
inexpensive, off-patent pills to control blood sugar, blood pressure, and bad cholesterol
(which together reduce risks by more than half); by low-dose aspirin to reduce heart disease
risk by 20-25 percent; by stopping smoking (the most important ‘treatment’ of all), and by
adopting a healthy diet and exercise. The most effective way to prevent diabetes is by losing
weight and getting exercise, but some pills also delay diabetes.
In 2006, the World Bank systematically assessed the cost-effectiveness and feasibility of
diabetes interventions in developing countries. They identified 14 life-saving treatments that
would be cost-effective in every developing region of the world, including four that would
23actually save money for everyone. The four cost-saving treatments are simple, minimal
control of high blood sugar and high blood pressure, foot care in people at high risk of ulcers,
and preconception care for women with diabetes. Subsequent research would add a daily
aspirin and possibly a daily statin drug to this list.
These diabetes treatments are not only inexpensive and cost-saving, they are straightforward
to distribute and easy for patients to take. Side-effects are rare at proposed dosages. Regular
monitoring is not essential. The pills are almost too inexpensive to be worth the risk of
counterfeiting. And treatments like these flow easily through a country’s existing, locally
governed healthcare infrastructure, strengthening the core institutions on which every
nation’s health ultimately depends.
Tragically, most of the cost-saving treatments recommended by the World Bank are rarely
used outside the industrialized world, despite saving medical care costs. A major reason is
that most of the health budgets of the poorest countries come from outside donors. These
donors focus almost all their resources on infectious disease and diseases affecting children.
However, because illness is the most important cause of destitution in the developing
world, the death, disability and poverty of parents and grandparents resulting from diabetes
and cardiovascular disease can have a devastating impact upon dependent children and
grandchildren.
Global medical care expenditures for diabetes
World expenditures for diabetes treatment are growing more quickly than world population.
In 2007, the world is estimated to spend at least USD 232 billion to treat and prevent diabetes
and its complications. By 2025, this lower-bound estimate will exceed USD 302.5 billion.
➜ In industrialized countries, about 25% of the medical expenditures for diabetes go
to treating elevated blood sugar; 25% go to treating long-term complications, largely
cardiovascular disease and 50% are consumed by the additional general medical care that
accompanies diabetes.
➜ For example, expenditures for a person with diabetes who has end-stage kidney disease
are 3 to 4 times higher than expenditures for a person with diabetes and no complications.
➜ In the United States, acute hospitalization consumes 44% of diabetes-attributable costs;
followed by:
➜ 22% for outpatient care;
➜ 19% for drugs and supplies; and
➜ 15% for nursing care.
➜ Similar proportions are reported for other high-income countries such as Finland.
➜ In middle-income countries, half of diabetes medical expenditures are used for blood sugar
control, which is essential for the prevention of acute life-threatening hyperglycaemia.
The remainder is split between general medical care and chronic complications.
24“The prevention and treatment of
diabetes can be highly cost-effective
and often cost-saving.”
© Jesper Westley
➜ In Latin America and the Caribbean, drugs to reduce blood sugar levels are believed to
account for about 50% of all spending.
➜ It is believed that in low-income countries almost all expenditure for diabetes is directed
towards drugs to prevent death from high blood sugar.
Disparities in spending for medical care
➜ More than 80% of expenditures for medical care for diabetes are made in the world’s
economically richest countries.
➜ Less than 20% of expenditures are made in the middle- and low-income countries where
80% of people with diabetes will soon live.
➜ One country, the United States of America, is home to about 8% of the world’s population
living with diabetes and spends more than 50% of all global expenditures for diabetes care.
➜ Europe accounts for another quarter of diabetes-care spending.
➜ The remaining industrialized countries, such as Australia and Japan, account for most of
the rest.
➜ In the world’s poorest countries, not enough is spent to provide even the least expensive
life-saving diabetes drugs.
If nothing changes, the disparity in spending for diabetes care between the industrialized
countries and the rest of the world will increase.
Access to care
Although the medical care costs of diabetes are much higher in industrialized countries,
nearly all of them have organized medical care insurance systems and/or governmental
provisions for medical services. This allows families to survive financially when diabetes
strikes. However, costs in these countries are higher than they need to be because insufficient
25money is invested to prevent expensive complications such as heart disease, stroke, kidney
disease and amputations.
In developing countries, most people living with diabetes bear the brunt of the medical
costs out of their own pocket, because the majority of such countries lack an adequate
healthcare infrastructure. Health budgets are usually very low compared to military and other
expenditures. Imported medicines are taxed for revenue, not subsidized. Doctors and nurses
are poorly paid and often emigrate to richer countries or leave the core medical care system
for the higher salaries paid by outside donors for infectious disease control. Kickbacks and
inappropriate incentives from drug manufacturers are not unknown. Drug distribution by
governments is unreliable, forcing people to buy from private pharmacies, which charge high
prices. Health insurance to spread risk is largely unknown.
Source: All economic impact data are drawn from the Diabetes Atlas, third edition,
International Diabetes Federation 2006.
26What is diabetes?
Diabetes is a chronic, potentially debilitating and often fatal disease. The disease occurs as
a result of problems with the production and supply of insulin in the body. Either the body
produces no or insufficient insulin (type 1 diabetes), or the body cannot use the insulin it
produces effectively (type 2 diabetes).
Insulin is a hormone made by the pancreas that helps ‘sugar’ (glucose) to leave the blood and
enter the cells of the body to be used as ‘fuel’.
Two types of diabetes
There are two main types of diabetes:
Type 1 diabetes is sometimes called insulin-dependent, immune-mediated or juvenile-onset
diabetes. It is caused by an auto-immune reaction where the body’s defence
system attacks the insulin-producing cells. The reason why this occurs is not fully understood. People
with type 1 diabetes produce very little or no insulin. The disease can affect people of any age, but
usually occurs in children or young adults. People with this form of diabetes need injections of insulin
every day in order to control the levels of glucose in their blood. If people with type 1 diabetes do not
have access to insulin, they die.
Type 2 diabetes is sometimes called non-insulin dependent diabetes or adult-onset diabetes. People
with type 2 diabetes do not usually require injections of insulin. Usually, they can control the glucose
in their blood by watching their diet, taking regular exercise, oral medication, and possibly insulin.
Type 2 diabetes is most common in people older than 45 who are overweight. However, as a
consequence of increased obesity among the young, it is becoming more common in children and
young adults. Type 2 diabetes is the most common type of diabetes and accounts for 90-95% of all
diabetes.
If people with type 2 diabetes are not diagnosed and treated, they can develop serious complications,
which can result in an early death. Worldwide, many millions of people have type 2 diabetes without
even knowing it. Others do not have access to adequate medical care. The onset of type 2 diabetes is
also linked to genetic factors but obesity, physical inactivity and unhealthy diet increase the risks.
Some women develop a third, usually temporary, type of diabetes called ‘gestational diabetes’
when they are pregnant. Gestational diabetes develops in 2-5% of all pregnancies, but usually
disappears when the pregnancy is over. Women who have had gestational diabetes have an
increased risk of developing type 2 diabetes later on.
Impaired Glucose Tolerance (IGT)
People with impaired glucose tolerance (IGT) have glucose levels that are above normal but below
the level at which diabetes is diagnosed. People with IGT have a significant risk of developing type
2 diabetes. They are thus an important target group for primary prevention. Changes in lifestyle,
including diet and physical activity can greatly reduce the onset of diabetes.
27Recognizing diabetes
The onset of type 1 diabetes is often sudden and dramatic
and can include symptoms such as:
➜ Abnormal thirst and a dry mouth
➜ Frequent urination
➜ Extreme tiredness/lack of energy
➜ Constant hunger
➜ Sudden weight loss
➜ Slow-healing wounds
➜ Recurrent infections
➜ Blurred vision
The same symptoms that are listed above can also affect people with type 2 diabetes, but
usually the symptoms are less obvious. The onset of type 2 diabetes is gradual and therefore
hard to detect. Indeed, some people with type 2 diabetes show no obvious symptoms early
on. These people are often diagnosed several years later, when various complications are
already present.
Life-threatening complications
Without proper insulin production and action, glucose remains in the blood, leading
to chronic hyperglycaemia (raised blood sugar). This can result in short and long-term
complications, many of which, if not prevented and left untreated, can be fatal. All have the
potential to reduce the quality of life of people with diabetes and their families.
The most common long-term complications are:
➜ Diabetic nephropathy (kidney disease), which may result in total kidney failure and in the
need for dialysis or kidney transplant.
➜ Diabetic eye disease (retinopathy and macular oedema), damage to the retina of the eye
which can lead to vision loss.
➜ Diabetic neuropathy (nerve disease), which can ultimately lead to ulceration and
amputation of the feet and lower limbs.
➜ Cardiovascular disease, which affects the heart and blood vessels and may cause fatal
complications such as coronary heart disease (leading to a heart attack) and stroke.
Diabetes is the fourth leading cause of death by disease globally. Every year, 3.8 million
people die from diabetes-related causes.
28Diabetes can be prevented
Changes to the living environment, early detection and the adoption of proven measures to
prevent diabetes can significantly lower the risk of developing type 2 diabetes, delay its onset
or at least reduce its impact. For people with type 1 diabetes, it is not yet possible to prevent
the disease. However, much can be done to prevent or delay diabetes complications if people
have access to adequate care, medication and monitoring equipment.
Diabetes facts
➜ Diabetes is a chronic disease marked by elevated blood glucose levels. It affects 5-6%
of the global adult population.
➜ Type 2 diabetes prevalence is rising at alarming rates worldwide because of increased
urbanization, high prevalence of obesity, sedentary lifestyles and stress, among other factors.
➜ Up to 80% of type 2 diabetes is preventable by adopting a healthy diet and increasing
physical activity.
➜ Diabetes is responsible for over one million amputations each year.
➜ People with diabetes are 15 to 40 times more likely to require a lower-limb amputation
compared to the general population
➜ Diabetes is the largest cause of kidney failure in developed countries and is responsible for
huge dialysis costs.
➜ Type 2 diabetes has become the most frequent condition in people with kidney failure
in countries of the Western world. The reported incidence varies between 30% and 40%
in countries such as Germany and the USA.
➜ 10% to 20% of people with diabetes die of renal failure.
➜ It is estimated that more than 2.5 million people worldwide are affected by diabetic
retinopathy.
➜ Diabetic retinopathy is the leading cause of vision loss in adults of working age
(20 to 65 years) in industrialized countries.
➜ On average, people with type 2 diabetes will die 5-10 years before people without diabetes
and mostly due to cardiovascular disease.
➜ Cardiovascular disease is the major cause of death in diabetes, accounting for some 50% of
all diabetes fatalities, and much disability.
➜ People with type 2 diabetes are over twice as likely to have a heart attack or stroke as
people who do not have diabetes. Indeed, people with type 2 diabetes are as likely to suffer
a heart attack as people without diabetes who have already had a heart attack.
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