Diabetes has strong links with poverty, poor nutrition, infectious disease, and many aspects of social and human development. This affect targets included in the Millennium Development Goals (MDGs) set and adopted by the global health community with a deadline for meeting specific goals by 2015. Many countries are still behind in their progress towards achieving the MDGs.
Diabetes affects individuals with lower socioeconomic status, as well as disproportionately affecting low- and middle-income countries, where the prevalence of diabetes and other NCDs are increasing and the burden of infectious diseases remains high. This ‘double burden’ of infectious and non-communicable diseases is undermining efforts to reduce poverty and achieve the MDGs in many countries. 1
Diabetes is a poverty issue (MDG1)
The economic impact of diabetes can be huge, through spending a large proportion of income on care, loss of income or work, or reduced productivity. For example, in India up to 25% of annual household income is spent on diabetes care. 2 The economic burden of diabetes and disability from complications can push poor families into destitution and poverty. At a national level the diabetes epidemic threatens to overwhelm health systems, and potentially reverse development gains made in low-income countries. 3 As a result, efforts to eradicate extreme poverty will be impeded.
Gender inequality and diabetes (MDG3)
Low socioeconomic, legal and political status of girls and women can increase exposure and vulnerability to the risk factors of diabetes, particularly in low- and middle-income countries. In countries with pronounced gender inequality, the low social status of girls and women can result in poor nutrition, and social norms can restrict physical activity.
If women have reduced access to essential healthcare for diabetes because of gender biases in power, resources, culture, and the organization of services this can result in increased risk of complications and death. Women and girls are also more likely to take on the burden of care for a family member diagnosed with diabetes, 4 thereby contributing to health inequalities between men and women, and weakening efforts to promote gender equality and empower women.
Diabetes and Maternal and Child Health (MDGs 4 and 5)
Diabetes is an important maternal health issue. Uncontrolled diabetes during pregnancy threatens the health of both mother and child, and is associated with the delivery of macrosomic or large for gestational-age infants. This can result in life-threatening and costly complications for the mother, such as obstructed labour, and complications that threaten the life and health of the newborn child.
Gestational diabetes (GDM) is also associated with several pregnancy complications and increased future risk of type 2 diabetes for mother and child.
Diabetes and infectious diseases (MDG6)
Despite a scope that included all major diseases, targets for MDG6 were focused on HIV/AIDS, tuberculosis (TB), and malaria (Table 4.2). A person with HIV/AIDS is vulnerable to diabetes, as the use of some drugs to treat HIV/AIDS can greatly increase the risk of diabetes. 5 People with diabetes are also at least 2.5 times more likely to develop TB. In India, 15% of TB can be attributed to diabetes.
There is some evidence that a person with diabetes has a higher chance of contracting malaria 6 and may have worse outcomes if they develop cerebral malaria. 7 These links show that unless diabetes is included in efforts to combat HIV/AIDS, malaria and TB the targets laid out by MDG6 will be harder to achieve.
Beyond targeting the increased risk of poor outcomes from these linked diseases, improvements in health systems, integrating care, and building capacity will provide the foundation for gains in all of these major causes of the disease burden.
1: Stuckler D, Basu S, McKee M. Drivers of inequality in Millennium Development Goal progress: a statistical analysis. PLoS Med 2010; 7 (3): e1000241.
2: Ramachandran A, Ramachandran S, Snehalatha C, et al. Increasing expenditure on health care incurred by diabetic subjects in a developing country: a study from India. Diabetes Care 2007; 30 (2): 252-256.
3: Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care 2011; 34 (6): 1249-1257.
4: World Health Organization. Women and Health: Today's evidence, tomorrow's agenda World Health Organization; 2009.
5: Young F, Critchley JA, Johnstone LK, et al. A review of co-morbidity between infectious and chronic disease in Sub Saharan Africa: TB and diabetes mellitus, HIV and metabolic syndrome, and the impact of globalization. Global Health 2009; 5: 9.
6: Danquah I, Bedu-Addo G, Mockenhaupt FP. Type 2 diabetes mellitus and increased risk for malaria infection. Emerg Infect Dis 2010; 16 (10): 1601-1604.
7: Eltahir EM, Ghazali GE, A-Elgadir TME, et al. Raised plasma insulin level and homeostasis model assessment (HOMA) score in cerebral malaria: evidence for insulin resistance and marker of virulence. Acta Biochim Pol 2010; 57 (4): 513-520.