Developing countries

Families of children with diabetes in developing countries are facing an impossible situation. In these regions, the full cost of managing a child with this condition is higher than the average total annual income. Consequently, children with diabetes frequently die quickly. To help alleviate this situation, IDF has commenced a sponsorship programme aiming to support children with diabetes in developing countries. The programme, Life for a Child, was launched at the 17th IDF Congress in Mexico City in November last year.

As in many countries of the world, Syria, with its 16 million inhabitants, has witnessed a tremendous change in food habits and lifestyle within the last few decades. This has been reflected in the rise of metabolic diseases in general and diabetes in particular. Three studies have shown that the prevalence of diabetes in Syria is probably higher than published reports have claimed. One of the aims of the Syrian National Diabetes Programme, adopted in 1995, was to assess the national situation by carrying out epidemiological studies.

The Tanzania Diabetes Association, established in 1985, is playing a crucial role in providing people in this extremely impoverished country with essential diabetes care. What, at the outset, may have seemed nearly impossible through a lack of funds, has, nevertheless, come into being through a well organized strategy and clear objectives.

The first systematic epidemiological studies in Iran were begun in 1993. However, in light of the growing number of people with diabetes and the accruing costs, estimated to exceed US$400 million a year, a need was recognized in 1998 to study the more recent epidemiology of diabetes in Iran. In 1998 the National Committee for Diabetes was formed, and a project undertaken in 1999 involving nearly 2.5 million people. Many other substantial moves have been made in Iran to help deal with diabetes in the country.

The prevalence of diabetes in Latin America will double within the next couple of decades. Type 2 diabetes is already among the first 10 causes of mortality in the Latin American adult population due to chronic complications related to premature and accelerated atherosclerosis. It is also estimated that around one third of these women and half of these men remain undiagnosed for years. Latin America must, therefore, be prepared for an epidemic with serious consequences.

Diabetes is on the increase in Indonesia, with prevalence rates now at 4.6% compared with 2% to 3% just five years ago. This means that some four million people throughout Indonesia, from Sumatra to Irian Jaya, currently have the condition. Bali, an Indonesian island with three million inhabitants, has trained 86 diabetes educators since 1996. The educators, who come from all over the island, are expected to be able to return to their local areas and spread their knowledge about diabetes.

The global prevalence of diabetes is set to double over the next 25 years. Developing countries like India, already top of the diabetes league, are expected to shoulder much of this burden. Epidemiological studies show that the prevalence of diabetes is particularly high in urban areas in India. Cities are also home to a large pool of people with a great risk of developing diabetes in the future.

For most Ethiopian immigrants arriving in Israel, diabetes was an unknown illness. However, current studies show that its prevalence is now high in this population. The diagnosis and management of diabetes among Ethiopian immigrants present a real challenge of acculturation. In response to this challenge, a community-based project called Tene Briut was created. Tene Briut promotes culturally-appropriate prevention, detection and management activities, with a major contribution from Ethiopian health professionals and community leaders.

Diabetes affects an estimated 3.3% of the adult population in Argentina. For many of these people, insulin is a life-sustaining drug. Without uninterrupted access to insulin, people dependent on this drug for survival face the real possibility of death, some within days. The collapse of the reimbursement system and speculation have caused grave interruptions in the supply of medicines such as insulin and now an emergency response is expected from the Argentinean authorities.

A publication that can help inform people with diabetes about their condition and keep them motivated to look after themselves would seem to be a valuable and cost-effective if not essential part of self-management. But in most parts of the poorly resourced continent of Africa, a magazine for people with diabetes is a luxury. Publishing is expensive and requires a supportive economy and a literate population with a common language.