Every 10 seconds one person dies of diabetes and two people develop the disease. Globally there are an estimated 300 million cases of diabetes, expected to rise to 438 million by 2030. In sub-Saharan Africa the disease is becoming a “silent pandemic”, yet diabetes remains neglected and people continue to suffer.
“Over the next 20 years, sub-Saharan Africa is predicted to have the highest growth in the number of people with diabetes of any region in the world, almost doubling to 23.9 million by 2030,” Prof Jean Claude Mbanya, president of the International Diabetes Federation (IDF), told delegates at the Diabetes Leadership Forum Africa 2010 in Johannesburg. The IDF is an umbrella organisation of over 200 national diabetes associations in over 160 countries.
“Diabetes is fast becoming a silent pandemic with over 300 million people living worldwide with the disease, and 80% of these are living in developing countries where they have little or no access to proper medical care,” he warned.
Africa’s health leaders and public health experts convened in Johannesburg on 30 September and 1 October to address Africa’s heavy disease burden and to push an integrated diabetes agenda forward for all African countries by targeting joint strategies for detection, prevention and management of diabetes and other non-communicable diseases. This agenda will be presented at the first United Nations Summit on non-communicable diseases (NCDs) in September 2011.
“Few realise the devastating effect diabetes is having on the people and healthcare systems in Africa,” says Mbanya, who also serves on the WHO African Advisory Committee on Health Research and Development. “Diabetes is a threat to public health and development that we have to address as a matter of extreme urgency.”
Health minister, Dr Aaron Motsoaledi, emphasised the need for a holistic and integrated approach to healthcare in his address to the Forum: “Health should be a priority not just for Health Ministries but for the entire public sector as well as the private sector. It should be a way of life and not just about medicine and treatment,” he said.
Many cases undiagnosed
It is estimated that a startling 12.1 million people are living with diabetes in Africa and this is thought to be just the tip of the iceberg, as many cases go undiagnosed. According to conservative estimates, as many as 24.2 million people on the continent could have impaired glucose intolerance (raised blood sugar), which could lead directly to them developing diabetes.
Diabetes is fast emerging as one of the biggest health catastrophes the world has ever seen. So much so that, by 2030, deaths from non-communicable diseases (NCDs) such as diabetes are expected to overtake deaths from such infectious diseases such as TB, malaria and HIV/Aids.
The World Health Organisation predicts that life expectancy will decrease worldwide for the first time in 200 years because of diabetes, and death rates are expected to rise by 25%.
Prof Pierre Lefèvbre, Chairman of the World Diabetes Foundation, compared the diabetes pandemic to a tsunami that is still growing.
"The international community needs to start taking this threat seriously. We must join forces in our fight against diabetes, otherwise we will jeopardise the health and lives of millions. Failure is not an option," Lefèvbre said. "Diabetes can be effectively managed, its impact reduced, and its onset in many cases prevented completely," he added.
Although type 1 diabetes is not a preventable disease, type 2 - which affects about 95% of people with diabetes - is. With lifestyle modifications, including dietary restrictions and exercise, it is estimated that 80% of all type 2 cases are preventable.
The main causes for the rise in diabetes are urbanisation, obesity, unhealthy lifestyle, lack of exercise and poverty, whereas the main barriers to diabetes care include lack of awareness, lack of access to medical care and, once again, poverty.
In the poorest countries, many people simply cannot afford medical care. The sad result is that many people who require insulin to survive, especially children with type 1diabetes, die prematurely. According to a diabetes care study published in The Lancet, a child diagnosed with type 1 diabetes in sub-Saharan Africa has a life expectancy that varies between 7 months and 7 years, depending on the country, compared to 60 years in Western Europe.
Although a number of initiatives from insulin-producing companies (such as Novo Nordisk, the Diabetes Leadership Forum sponsor), have attempted to improve insulin supply by cutting prices to just 20% of the full price sold in developed countries, the price of insulin to the user is still inflated along the distribution chain.
Diabetes and pregnancy
Furthermore, many pregnant women go undiagnosed with gestational diabetes which can cause health complications and put both the mother and child at risk of developing type 2 diabetes at a later stage of their lives.
The serious complications of diabetes (such as blindness, amputations, stroke, heart disease and renal failure) also have a major impact on families and the community at large, as the people suffering from diabetes are often the sole providers of income.
“The men and women most affected by diabetes are of working age – the breadwinners of their families,” says Mbanya.
Says Dr Anil Kapur, Managing Director of the World Diabetes Foundation: “To alleviate the burden of disease, it is time for all partners to start seeing communicable and non-communicable diseases as two related areas and to explore joint strategies for detection, prevention and management, building on the same infrastructure and health care capacity.
Integrated strategic plan
The World Diabetes Foundation recommends, for example, early screening for diabetes, carried out when people are seeking treatment for other conditions would improve early detection and treatment of diabetes.
“If we fail to implement an integrated strategic plan for the management of diabetes and related health risks in all of the countries of the African Union, Africa’s healthcare system could simply collapse under the load,” the IDF’s Mbanya cautioned.
“Let us also join hands in launching a concerted campaign against non-communicable diseases," Motsoaledi said, "if we fail in doing this, there is every chance that our nation will be robbed of its future."
In September 2011, the United Nations will hold its first ever summit on Non Communicable Diseases (NCDs) including diabetes. Over 100 countries have indicated that NCDs have become a global priority for world leaders and a core development issue on the global agenda.
Says the IDF’s Mbanya: “This is a key opportunity to put in place change that will save millions of lives now and set in place a better future for our children and grandchildren - an opportunity that can’t afford to lose.”
* The Diabetes Leadership Forum Africa 2010 was jointly hosted by the Department of Health, on behalf of the South African government, and the World Diabetes Foundation; and was supported by the International Diabetes Federation and co-organised and sponsored by global health care company Novo Nordisk.
- (Birgit Ottermann, Health24, October 2010)
(World Diabetes Foundation, International Diabetes Federation, Novo Nordisk, Diabetes South Africa, Diabetes: the hidden pandemic and its impact on Sub-Saharan Africa – Document prepared for the Diabetes Leadership Forum Africa 2010 - Edited by Prof Ayesha Motala and Dr Kaushik Ramaiya, 2010)