Diabetes is a group of metabolic diseases, clinically known as Diabetes mellitus, in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. Glucose is vital to human health because it's the main source of energy for the cells that makes up muscles and tissues and that is why it is the main source of fuel of the body. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). If anyone has diabetes, no matter what type, it means he has too much glucose in his blood, although the reasons may differ and too much glucose can lead to serious health problems.
There are three main types of diabetes:
Type 1 diabetes: results from the body's failure to produce insulin, and requires the person to inject insulin. (Also referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)
Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.
Type 3, Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM. All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight.
People all over the world, especially in developing countries, have the impression that diabetes is a disease of the rich. That is NOT the case. Diabetes is rising faster in developing countries like Bangladesh. There are many reasons for this, but a key reason is that lifestyles are changing faster in developing countries.
This change is related to urbanisation and globalisation. One can't stop it, it is part of civilisation. What is of concern is that with this increased urbanisation people are getting less physical exercise. Even if they want to exercise, there's less space to do that. Workplaces, schools and colleges have few or no facilities for physical activity.
The increase in diabetes in Bangladesh is expected to follow global gender patterns, whereby more women than men will live with diabetes. IDF and WHO predict that the number of women in the world with diabetes will double in less than 20 years. In Bangladesh the number of women with diabetes will grow from the current 2 million to 4 million by 2025. During the same period, men with diabetes will rise from 1.8 million to 3.4 million . Mirroring trends across the region, the urban population with diabetes in Bangladesh is expected to increase dramatically over the next 20 years.
The main conclusions reached by a recent study by International diabetes Federation include the following:
First, diabetes imposes a large financial burden on people with diabetes and their families. The size of this burden depends on their economic status and the social insurance policies of the countries in which they live. Individuals with diabetes and their families in developing countries pay a larger share of the expenditure because of the poorer organized systems of medical care insurance and/or lack of governmental provision of medical services. In Latin America, families pay 40-60 per cent of expenditures for medical care from their own pockets. In the poorest countries, people with diabetes and their families bear almost the whole cost of whatever medical care they can afford. In India, for example, the poorest persons with diabetes spend an average of 25 per cent of their total income on healthcare.
Second, at the societal level, diabetes leads to loss in productivity and economic growth. The American Diabetes Association estimated that the US economy lost USD$58 billion, equivalent to about half of the direct health care expenditure on diabetes in 2007, as a result of lost earnings due to lost work days, restricted activity days, lower productivity at work, mortality and permanent disability caused by diabetes. Such losses are perhaps relatively larger in poorer countries because premature death due to diabetes occurs at much younger ages. The World Health Organisation (WHO) predicts net losses in national income from diabetes and cardiovascular disease of US$ 446 billion in China, US $ 242.6 billion in the Russia, US $ 269.3 billion in India, US$ 39.4 billion in Brazil, and US$2 billion in Tanzania between 2005 and 2015.
Finally, the largest economic burden caused by diabetes is the monetary value associated with disability and loss of life as a result of the disease itself and its related complications, including heart, kidney, eye and foot disease. Economists have used different methods to value disability and loss of life associated with diseases and the most appropriate method is still under debate.
Fortunately, the economic burden of diabetes can be reduced by implementing many inexpensive, easy-to-use interventions, and most of the interventions are cost-effective or cost-saving, even in the poorest countries. Unfortunately, these interventions are not widely used in poor and middle income countries. More resources should be invested to deliver these cost-effective interventions, in particular to those in the developing countries where the great majority of persons with diabetes live.
Figures indicate that health expenditures for diabetes will grow by 30 to 34 per cent between 2010 and 2030, which is more than the assumed global population growth (28.6 per cent) among persons aged 20-79 years over the same period. Expenditures will grow more quickly than population because the global prevalence of diabetes will increase as a result of ageing and increasing urbanisation.
More than three-quarters of global expenditure for the care of diabetes are now used for persons who are between 50 and 80 years of age. This is because the prevalence of diabetes is much higher in older age-groups, and because persons who have lived with diabetes for many years have higher rates of complications, which are expensive to treat. Also, countries that spend the most per capita for diabetes have older populations, and type 2 diabetes in these countries begins at older ages. More money is expected to be spent on diabetes care for women than for men. Study also shows that per capita diabetes care expenditure are higher for women than for men, especially at younger ages.
Dr Muhammad Abdul Mazid, Former Secretary to GoB, Chairman of NBR and Member of the National Council, Diabetic Association of Bangladesh.
