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

2. 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

3. 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).

4. 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

5. 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
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).

6. 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

7. 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).

8. 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

9. 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.

10. 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

11. 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

12. 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).

13. 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).

14. 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

15. References
Colagiuri, R., Brown, J., & Dain, K. (2010, November). In Steve Jones (Chair). A call to action on diabetes. Idf expert meeting. Retrieved from to-Action-on-Diabetes.pdf
Diabetes and development. (2013). Retrieved from
IDF diabetes atlas update (2012). Retrieved from

16. References
Levine, J. A. (2011, November). Poverty and obesity in the U.S. Retrieved from content/60/11/2667.full
Nordqvist, C. (2013, April 12). All about diabetes. Retrieved from
The global burden. (2013). Retrieved from