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Diabetes: The Silent Killer

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Diabetes is a disease that happens when your blood glucose (glucose) is too high. Diabetes is a chronic and metabolic disease that causes serious damage to the heart, blood vessels, eyes, kidneys and nerves in the body. There are mainly two types of diabetes, type 2 diabetes, which occurs when the body becomes insulin resistant or does not make enough insulin. The majority of diabetics have type 2 diabetes and are primarily preventative in adults. This type of diabetes is in large part a result of being overweight and physically inactive. According to International Diabetes Federation (IDF), there are many risk factors associated with Type 2 diabetes: family history, ethnicity, high blood pressure, High BMI with waist size larger, physically inactive as well as gestational diabetes.  The other one is type 1 diabetes, referred to as juvenile diabetes or insulin dependent diabetes. Type 1 diabetes is a chronic disease where the pancreas produces little to no insulin per se. Symptoms include excessive urination, thirst, constant hunger, weight loss, vision changes and tiredness. These symptoms can occur suddenly (WHO, 2021).

According to WHO and IDF, in 2014, 8.5 per cent of adults were diabetic. In 2019, 4.2 million people died as a direct result of diabetes. As well, between 2000 and 2016, premature mortality from diabetes increased by 5% in high- and low-income countries. Today, close to 463 million people worldwide suffer from diabetes, with the majority coming from low- and middle-income countries. Interestingly, this number has gradually increased in recent decades and there are 1.6 million deaths directly attributed to diabetes. If the current trend continues, 700 million adults will have diabetes by 2045.

The cost of diabetes is considerable and growing at an alarming rate, particularly in low- and middle-income countries. According to IDF (Table 1), total health spending for diabetes is US$760.3 billion worldwide and is projected to be US$845 billion by 2045. It’s just the health expenditures, and it’s more along with the other direct and indirect costs associated with diabetes with the country differences. At country level, the highest diabetes-related health expenditures were estimated for USA (USD 294.6 billion), followed by China and Brazil, with USD 109.0 billion and USD 52.3 billion, respectively (IDF, 2019). Countries with the lowest diabetes-related healthcare spending were Sao Tome, Principe, and Tuvalu with estimates of $1.1 million and $1.8 million.

Table 1. Global Diabetes estimation and projections (IDF, 2019)

Source: IDF DIABETES ATLAS Ninth edition 2019

According to the research findings the prevalence of diabetes in adult women is slightly lower than in men, and there are about 17.2 million more men than women living with diabetes. Taking into account the working age (20-64 years), close to 351.7 million people have diagnosed or undiagnosed diabetes in 2019.  It is expected that this figure will reach 486.1 million by 2045. Interestingly, the largest increase will occur in regions where economies are transitioning from low- to medium-income IDF countries, 2019). The prevalence of diabetes is lowest for adults aged 20-24 years, 1.4% and highest for adults aged 75-79 years, 19.9% in 2019. As a result, more attention should be given to the control of diabetes among older adults (Figure 1).

Figure 1. Prevalence of diabetes by age group in adults (0-79 years) in 2019, 2030 and 2045.

Urbanization, and changing lifestyle habits that leads to the higher calorie intake, increasing consumption of processed foods and sedentary lifestyles are influential factors for increasing type 2 diabetes at a societal level. Urban areas report greater levels of diabetes than rural areas. In 2019, 310.3 million people lived with diabetes (10.8%) in urban areas, while the number was 152.6 million (7.2%) in rural areas. The number of people with diabetes in urban areas is expected to increase to 538.8 million (12.5%) in 2045 with the increasing globalization (Figure 2).

Figure 2. Number of people with diabetes in urban and rural areas.

The age-adjusted comparative prevalence estimates and IDF projections show that the Middle East and North Africa (MENA) region has the highest age-adjusted comparative prevalence of diabetes among adults. The Africa Region (AFR) has the lowest age-adjusted comparative prevalence that can be attributed to lower levels of urbanization, undernutrition and overweight and obesity (Table 2).

Given diabetes at the national level, most adults with diabetes are reported in China, India and the United States. Table 3 shows the top ten countries affected by adult diabetes, and you can see that, except in the US and Germany, all other countries are low- and middle-income countries (Table 3).

Table 2. Prevalence of diabetes in adults in IDF regions in 2019, 2030 and 2045, ranked by 2019 age-adjusted comparative diabetes prevalence.

Source: IDF DIABETES ATLAS Ninth edition 2019

Table 3. Top 10 countries of adults with diabetes in 20190, 2030, and 2045

Source: IDF DIABETES ATLAS Ninth edition 2019

How to Prevent Diabetes

Prevention of type 1 diabetes is not that effective, and no one knows how to prevent type 1 diabetes. However, it can be managed through healthy living, blood sugar management, regular health checks, weight control, and diabetes self-management education and support.

Preventing or delaying the onset of type 2 diabetes can be reached through changing some behavioral activities. According to the research studies, positive changes include avoiding sugar, work out regularly, drink water as the primary beverage, maintaining healthy body weight, quit smoking, follow very low carb diet, watch portion sizes, avoid sedentary behaviors, avoid saturated fat, eat a high fiber diet, optimize vitamin D level in the blood, minimize intake of processed food, drink coffee or tea, and taking natural herbs.  These simple behavioral changes are easy to make if someone is seriously considering being away from diabetes.

Diabetes adds a heavy burden to the economy of a family, country as well as the world. Though the world needs some efficient and effective policies related to food and agriculture, health and safety, food production systems, and others to control diabetes, individually anyone can work for preventing diabetes through his/her behavioral changes as shown before. Strengthening the health and activities of the community is part of the community’s social responsibility.  By changing yourself you can do your duty to the society. Think seriously! We can defeat that silent assassin!

Saman Janaranjana Herath
Saman Janaranjana Herath
PhD (NRE). MBA (Fin). Associate Professor, University of Mount Olive, North Carolina, USA. Writer,


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