Healthcare costs

The latest statistics suggest that in the future the majority of people with diabetes will live in developing countries. There are an estimated 35 million people living with diabetes in India, for example, and it is estimated that this number will rise to more than 73 million by 2025. Sadly, it follows that the majority of people with diabetes complications will come from countries whose health systems are not able to deliver quality diabetes care.

The first practical use of insulin by Banting and Best in 1921 heralded a medical revolution. Overnight, type 1 diabetes went from being a uniformly fatal disease to a manageable disorder. Thousands of people around the world have received awards for surviving 50 years on insulin – some reaching 80 years. Insulin is classified by WHO as an essential drug. Yet, 85 years after its discovery, untold thousands of people with type 1 diabetes and type 2 diabetes in developing countries die each year because they can neither readily access nor afford insulin.

At 7.59 am local time on 26 December 2004, a mighty earthquake rocked the floor of the Indian Ocean just northwest of Sumatra, triggering a series of large and powerful tsunamis that killed nearly a quarter of a million people – 168 000 in Indonesia alone. The tsunami decimated towns and cities from Indonesia, Thailand and the north-western coast of Malaysia to Bangladesh, India, Sri Lanka and the Maldives, thousands of kilometres away, and as far as Somalia, Kenya and Tanzania in East Africa.

I am a forty-seven year old white male living in Ypsilanti, Michigan, USA. For most of my life, I have lived in either southeast Michigan or northwest Ohio. I hold a Masters Degree and Bachelors Degree in Geology. For the last 17 years I have been employed in some form or another in the environmental resources divisions of major US car manufacturers. But neither my studies nor my employment record prepared me for the difficulties I have faced and the adversity I continue to endure in attempting to manage my diabetes.

The third edition of the Diabetes Atlas was launched in December 2006, at the 19th World Diabetes Congress of the International Diabetes Federation (IDF) in Cape Town, South Africa. The aim of the Atlas, which has been described as the flagship publication of IDF, is to provide the most recent and accurate information on diabetes in 2007 and provide estimates of the likely impact of the condition up to 2025. Its purpose is to disseminate the most up-to-date and salient facts concerning the scope, impact and burden of diabetes globally and on a regional and country-by-country basis.

As early as 1989, the St Vincent Declaration warned Europeans of the dangers of ignoring the burgeoning diabetes epidemic. The Declaration called on governments, diabetes organizations and professional societies from countries throughout Europe to unite in efforts to tackle the growing challenge to healthcare in the region. There were high hopes among the European diabetes community that significant action would be taken. But despite the broad stakeholder support for the Declaration’s objectives, significant progress failed to materialize.

The human population of our planet is aging. According to UN projections, by the middle of this century, the number of elderly people in the world will exceed the number of young people – for the first time in history. This trend started during the last half of the 20th century. Yet policy-makers are only now becoming aware of the gravity of the implications for developing countries of the rapid pace at which our populations are ageing.

When I met Sonia Carrasco, 14 years ago, she was suffering from diabetes ketoacidosis – extremely high glucose levels, a sign of poorly controlled diabetes. Although she had been living with the condition for about 6 years, her diabetes knowledge was minimal, reflecting a general lack of health awareness. When I asked Sonia to describe her feelings the day she was given a diagnosis of type 1 diabetes, 20 years before, she recalls an experience made all the more terrifying by an acute fear of the unknown. She had understood that she had leukaemia.

My daughter Jacklyin was born in January 1990, three months premature. Her early birth gave her unusual status among her family and the rest of the community in our village, Gumine – in the Province of Chimbu, in the highlands of Papua New Guinea. She would always be given our special protection and ate the best of all children in the village.

The 10-year National Diabetes Programme in Finland (DEHKO) has been up and running for 6 years. The formal evaluations carried out to date indicate that the Programme continues to have a positive impact in a number of areas of diabetes care in Finland. Moreover, prevention of type 2 diabetes and cardiovascular complications remain the principle objectives of DEHKO. Timo Saaristo and Leena Etu-Seppälä report on FIN-D2D (2003-2007), the DEHKO project to implement primary prevention of type 2 diabetes in five regions – potentially affecting 1.5 million people.