Eating Healthy - Diabetes in resource-poor Africa

Diadetes best known in African languages as a “disease of sugar” is virtually getting out of hand.
Many of us over 50 years old with a sweet tooth are suffering yet we most likely would feel so much better if we cut out sugar from our diets altogether. Of course it is not just increased sugar intake that is associated with diabetes.

Global health experts have watched with increasing alarm as the waistlines of people in developing countries have started to widen with the adoption of a "Western" lifestyle. Obesity is of such concern because of its heightened risks for other diseases, such as heart disease, cancer, and diabetes.

In developing countries, the number of people with diabetes is set to rise to 228 million by 2030 from 84 million estimated in 2000. The link between obesity and diabetes is strong because obesity renders individuals unable to properly process glucose — about 90% of type 2 diabetes is due to being overweight. Obesity and diabetes also raise the risk for cardiovascular disease and kidney disease. Diabetic nephropathy was the most common cause of end-stage renal disease in 9 out of 10 Asian countries, which could be deadly for countries unable to cope with the health repercussions.

The prevalence of diabetes has reached epidemic proportions.
WHO predicts that developing countries will bear the brunt of this epidemic in the 21st century, with 80% of all new cases of diabetes expected to appear in the developing countries by 2025.

In a generation, diabetes has had a six-fold increase. In 1985 there were an estimated 30 million people globally with diabetes. Today diabetes affects more than 230 million people, almost 6% of the world's adult population.

The number of people living with diabetes is expected to grow to 350 million in less than 20 years if action is not taken.

Diabetes is one of the major causes of premature death worldwide. Every 10 seconds a person dies from diabetes-related causes. The death rates are predicted to rise by 25% over the next decade.
Diabetes is increasing faster in the world's developing economies than in developed countries. Seven out of ten countries with the highest number of people living with diabetes are in the developing world. With an estimated 35 million people with diabetes, India has the world's largest diabetes population.
Each year another 6 million people develop diabetes. In many countries in Asia, the Middle East, Oceania and the Caribbean, diabetes affects 12-20% of the adult population.
Sub-Saharan Africa suffers both under- and over-nutrition and here too diabetes is taking its toll.
Diabetes is a silent epidemic that claims as many lives each year as HIV/AIDS. In 2007, diabetes is said to have caused 3.5 million deaths globally.
If present trends persist, by 2025 the majority of people with diabetes in the developing countries will be in the 45-64 age group.
Type 2 diabetes is responsible for 90-95% of diabetes cases. 80% of type 2 diabetes is preventable by changing diet, increasing physical activity and improving the living environment.

Lack of sufficient diagnosis and treatment

In developing countries, less than half of people with diabetes are diagnosed. Without timely diagnoses and adequate treatment, complications and morbidity from diabetes rise exponentially.
Studies carried out recently in Zambia, Mali and Mozambique highlight a stark reality: a person requiring insulin for survival in Zambia will live an average of 11 years; a person in Mali can expect to live for 30 months; in Mozambique a person requiring insulin will be dead within 12 months.
Diabetes is responsible for over one million amputations each year, a large percentage of cataracts and at least five percent of worldwide blindness is due to diabetic retinal disease. Diabetes is the largest cause of kidney failure in developed countries and is responsible for huge dialysis costs.The risk of heart disease and stroke are all significantly higher for people with diabetes.
In some cases indispensable for survival, and in others necessary to maintain normal blood sugar levels, insulin remains underutilised in many developing countries. Culturally-based misconceptions and chronic shortages are just some of the reasons for this.
The diabetes pandemic, which consists primarily of type 2 diabetes, has evolved in association with rapid cultural changes, aging populations, increasing urbanisation, dietary changes, decreased physical activity and other unhealthy lifestyles and behavioural patterns. Without effective prevention and control programmes, the incidence of diabetes is likely to continue rising globally.
It may seem strange that the developing world, which is often associated with hunger and inadequate nutrition for children, is now experiencing an epidemic in type 2 diabetes, a malady related to wealth and unhealthy lifestyle. This can be explained with the high degree of urbanisation in some countries like e.g. India that have made people adapt the lifestyle from the industrial countries causing diseases such as diabetes related to this new lifestyle. It is also a fact that some people genetically have a higher risk of developing diabetes and combined with great changes in lifestyle this risk has turned to reality for many people in those countrie

Diabetes costs a burden for families and society

Because of the chronic nature of the disease, the severity of its complications and the means required to control them, diabetes is a costly disease. Mechanisms for financing health care are non-existent in most developing countries and health costs therefore typically represent out-of-pocket expenditure. In many instances, the choice is between health care and food or clothing, and such financial constraints inevitably result in under-consumption of health care services.
According to WHO, 80% of people in developing countries pay directly for some or all of their own medicine. In Latin America, families pay 40-60% of diabetes care costs out of their own pockets. For a low-income Indian family with an adult with diabetes, as much as 25% of family income may be devoted to diabetes care.
In 2007, the world will spend an estimated 215-375 billion USD to care for diabetes and its complications. If nothing is done over the next 20 years, the figure will rise to between 234 billion and 411 billion USD. Diabetes is growing fastest in low- and middle-income countries. It is, therefore, the developing countries that will bear the brunt of the spiralling costs.
In developing countries, the prevailing poverty, ignorance, illiteracy and poor health consciousness further add to the problem. Those who cannot afford or do not have access to even bare minimum health care facilities are likely to be diagnosed late and suffer from diabetes related complications (because of delay in diagnosis and/or improper treatment). Furthermore, many people with type 1 (i.e. insulin dependent) diabetes die before they are diagnosed, or soon after diagnosis, due to inadequate access to treatment.
The World Health Organization (WHO) estimates that diabetes, heart disease and stroke together will cost about $555.7 billion in lost national income in China over the next 10 years, $303.2 billion in the Russian Federation; $336.6 billion in India; $49.2 billion in Brazil and $2.5 billion even in a very poor country like Tanzania. These estimates are based on lost productivity, resulting primarily from premature death.

Source: IDF, Diabetes Atlas, 2nd and 3rd edition
Updated November 2006

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Compiled by:
Ruth Oniang’o