Diabetes: A Burden on Society By Victoria Tarrant April 26, 2013 HSC4624 Global Health

What is Diabetes? Diabetes mellitus, commonly known as diabetes, is a metabolic disease. It is one of the most common non-communicable diseases globally. The person will have high blood glucose, either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both (Nordqvist, 2013). There are two types: Type 1 – insulin-dependent diabetes, juvenile diabetes, or early-onset diabetes Type 2 – insulin resistant diabetes Metabolism - the way our bodies use digested food for energy and growth Glucose – a form of sugar in the blood Insulin – hormone produced in the pancreas that regulates amount of glucose in blood

Diabetes continued Type 1 insulin-dependent Not as common as type 2 Only 10% of all cases are type 1 Often develop in early adulthood or teenage years 78,000 children develop type 1 diabetes every year ("The global burden," 2013) Take insulin injections for rest of life The prevalence of type 1 diabetes in people <20s in the USA rose 23% between 2001 and 2009 (Nordqvist, 2013).

Diabetes continued Type 2 insulin-resistant About 90% of all cases worldwide Can be controlled by: Losing weight Following healthy diet Plenty of exercise Monitoring blood glucose levels However, typically is a progressive disease People of Middle Eastern, African, or South Asian descent with a close relative who have/had type 2 diabetes have a higher risk of it developing (Nordqvist, 2013). Type 2 is linked to overweight and obese people. Being overweight/obese causes the body to release chemicals that can destabilize the body's cardiovascular and metabolic systems (Nordqvist, 2013). Type 2 gradually gets worse with age and will most likely need to take insulin

Worldwide In 2012 >371 million people had diabetes 4.8 million people died due to diabetes >471 billion U.S. dollars were spent on healthcare for diabetes Statistics gathered from International Diabetes Federation Diabetes Atlas 2012 http://www.idf.org/diabetesatlas/5e/Update2012 New studies that were reviewed came from Saudi Arabia, Japan, Micronesia, Chile, Pakistan, Senegal, Myanmar, and other countries which add to the evidence of the growing burden of diabetes ("IDF diabetes atlas," 2012).

Worldwide In 2012 The Western Pacific has the highest prevalence of diabetes at 132 million (6 of the top 10 countries) Africa has the lowest at 15 million Picture retrieved from International Diabetes Federation Diabetes Atlas 2012 http://www.idf.org/sites/default/files/5E_IDFAtlasPoster_2012_EN.pdf

Diabetes and Poverty Both of these go hand in hand – each can cause the other Diabetes is becoming more and more common among the poor and marginalized Cost of treatment and/or loss of employment and income push families to poverty A large portion of family income is spent on healthcare for family members Many diabetic subjects spend 25-35% of their annual income on diabetes management (Levine, 2011).

Diabetes and Poverty continued The poorest countries have the greatest sedentariness and obesity (Levine, 2011). Violence follows poverty, preventing people from being active outdoors Some people living in poverty-dense regions are not able to afford a gym membership, sports clothing, or exercise equipment Parks and sports facilities are less available to people living in poor counties

Diabetes and Poverty continued Millions of people with diabetes face stigma and discrimination. Creates barriers to services, employment, and even marriage Greater impact on children, indigenous people, ethnic minorities, women and the poor.

Poverty and Obesity People who live in the most poverty-dense countries are those most prone to obesity (Fig. A) Variance in obesity can be accounted for by variance in sedentariness (Fig. B). The poorest countries have the greatest sedentariness (Fig. C) Countries with greatest rates of poverty have greatest diabetes rates too (Fig. D). Talk about four graphs on next slide

Poverty and Obesity continued People who live in the most poverty-dense countries are those most prone to obesity (Fig. A) Variance in obesity can be accounted for by variance in sedentariness (Fig. B). The poorest countries have the greatest sedentariness (Fig. C) Countries with greatest rates of poverty have greatest diabetes rates too (Fig. D). (Levine, 2011). Picture retrieved from American Diabetes Association 2011 http://diabetes.diabetesjournals.org/content/60/11/2667.full

Diabetes and Education Children with diabetes can have less access to education. Children with Type 1 diabetes are sometimes denied entry to school. Diabetes and education are linked The higher education, the lower the risk Diabetes limits education Cost People with higher education have a lower chance of getting Type 2 diabetes. For households in low income countries, the financial and time burden of diabetes can negatively impact on children’s educational attainment and performance, particularly so for girls (Colagiuri, Brown & Dain, 2010).

Diabetes and Development All nations, rich and poor, are suffering the impact of the diabetes epidemic Diabetes particularly affects those who are socially and economically disadvantaged 4 out of 5 people with diabetes live in countries classified by the World Bank as low- and middle- income countries (“Diabetes and development,” 2013) Diabetes increases the risk of developing tuberculosis Diabetes threatens achievement of the Millennium Development Goals Of the 3.6 billion adults living in low- and middle-income countries in 2011, 291 million have diabetes. This is compared to 75 million adults with diabetes living in high-income countries (“Diabetes and development,” 2013).

Diabetes is an important cause of cardiovascular disease Diabetes increases the risk of tuberculosis (TB) Cardiovascular disease is the leading complication and cause of death among people with diabetes. People with diabetes are three times more likely to develop TB and more likely to die from it Well-designed towns and cities with good public transport and food systems that encourage physical activity and healthy foods can simultaneously reduce risks for diabetes and carbon emissions. In people with diabetes, depression can lead to poor self-care and compromises quality of life (Colagiuri, Brown & Dain, 2010). Diabetes shares common risks and solutions with climate change Diabetes can cause or exacerbate mental health problems. Picture retrieved from International Diabetes Federation The Millennium Development Goals http://www.idf.org/diabetesatlas/5e/diabetes-and-the-millennium-development-goals

References Colagiuri, R., Brown, J., & Dain, K. (2010, November). In Steve Jones (Chair). A call to action on diabetes. Idf expert meeting. Retrieved from http://www.idf.org/webdata/Call- to-Action-on-Diabetes.pdf Diabetes and development. (2013). Retrieved from http://www.idf.org/diabetesatlas/5e/diabetes-and-development IDF diabetes atlas update 2012. (2012). Retrieved from http://www.idf.org/diabetesatlas/5e/Update2012

References Levine, J. A. (2011, November). Poverty and obesity in the U.S. Retrieved from http://diabetes.diabetesjournals.org/ content/60/11/2667.full Nordqvist, C. (2013, April 12). All about diabetes. Retrieved from http://www.medicalnewstoday.com/info/diabetes/ The global burden. (2013). Retrieved from http://www.idf.org/diabetesatlas/5e/the-global-burden