Diabetes Views - The emerging response to diabetes

Thirty years ago, when I was a young doctor at the Central Hospital in Yaoundé, Cameroon, a heart attack was highly unusual ‒ so rare an occurrence, in fact, that medical students at the hospital were called in to take a look at any new case. Today, however, cardiovascular diseases, along with diabetes and the other non-communicable diseases, cancer and chronic respiratory diseases, are the most common killers in Cameroon and throughout West Africa. Unaware of the generational damage being done over recent years by the deadly interplay between genetic inheritance and socioeconomic factors (including sweeping rural-urban migration, the rapid loss by large sectors of society of their traditional lifestyles and the proliferation of processed foods), we now find ourselves living in one of the world’s new and unlikely diabetes hotspots.

This is happening throughout the developing world: diabetes and other NCDs are striking down working-age people living in the countries that can cope least well. Worldwide, four out of five people living with chronic disease are in one of the low- and middle-income countries. And the epidemic has only just begun. By 2030, the number of people living with diabetes worldwide will be greater than the current population of North America ‒ half a billion!

Yet while overweight and diabetes are on the increase, millions of children go to bed each day hungry ‒ not just pangs of hunger; starving, lacking the essential nutrients for their physical and mental development. Of the two major crises in the world today – financial disarray and soaring food prices – the latter is perhaps the more distressing.

Drastic swings in the prices of staple foods are causing ripples of misery and hunger throughout the developing world. A recent report by OXFAM projects that the average price of staple foods will more than double in the next 20 years. The urban poor will assume much of the burden of higher prices by having to spend more and more of their household income on food ‒ at the expense of other essentials like housing, healthcare and education. In many developing countries, the poorest people already spend up to 80% of their income on food.

We are now aware of the strong links between a mother’s malnourishment, her baby’s birth weight and the child’s future risk for the constellation of metabolic disorders that leads to diabetes.

This is particularly important in sub-Saharan Africa and the Indian Subcontinent, where high levels of under-nutrition co-exist with rapid changes in nutrition in young adulthood.India is home to a quarter of the world’s starving people. Yet it also has the second largest diabetes population in the world ‒ over 50 million people and counting ‒ most of these with lifestyle-related type 2 diabetes.

All of this puts a whole new spin on diabetes care and prevention. We must factor in undernutrition and poverty as well as over-nutrition. We must remove any blame for type 2 diabetes from the shoulders of the individual. And we must find simple cost-effective interventions to avoid the human tragedy and crippling cost of diabetes. The search for such an approach represents one arm of IDF’s response to the burgeoning crisis in health and development, and is the focus of a number of articles in this special issue. Work on some of these projects is in progress; I look forward to reading the results of the translational research underpinning their implementation and assessment in
future editions of this magazine.

Another hugely important area of our activities, as regular readers will be aware, is in the lead-up to the UN summit on NCDs this September. IDF recently published a set of recommendations that members want to see included in the UN Summit Outcomes Document. The NCD Alliance’s Proposed Outcomes Document contains 34 carefully considered goals and targets that represent our vision of success. To read the Document in full, please visit the IDF website and follow the links.