Developing countries

In the 1950s and 1960s diabetes prevalence in Ghana was estimated at between 0.2% and 0.4% in adults. However, a recent analysis of admissions to the largest hospital in the country reveals that diabetes accounts for 6.8% of all adult admissions. Despite the fact that diabetes is clearly a major health problem in Ghana, the country has no separate diabetes healthcare policy. To address these issues, a three-year national programme, the Ghana Diabetes Programme, was initiated in 1995.

The political and social situation in the Gaza Strip remains tense, with considerable disruption of normal economic and social activity. Such an environment is rarely conducive to the delivery of continuing medical care. In this article Panagiotis Tsapogas, Medical Co-ordinator of the Greek section of Médecins Sans Frontières (Doctors Without Borders) in Gaza, 2002-2003, reports on the difficulties faced by Palestinian people with diabetes in Gaza, and makes a call for the provision of improved diabetes care.

Diabetes poses a serious threat to developing countries like Bangladesh. Despite advances in diabetes treatment, management and self-care, women with diabetes in rural Bangladesh are rarely able to enjoy the fruits of this progress.

Being a woman and having diabetes can mean double discrimination for women all over the world. Even more so in many developing countries, where women, whether they have diabetes or not, still have to fight harder than ever to achieve equal rights and equal opportunities. This article, however, will not offer a helpless victim's point of view.

There is a rapidly rising epidemic of Type 2 diabetes throughout the world. It is particularly severe in developing countries. In 1995, 62% of people with diabetes in the world lived in developing countries. By 2025 this is predicted to rise to more than 75%. In India there are an estimated 25 million people with diabetes, and this will rise to more than 60 million by 2025. One in five people with diabetes in the world will then be Indian. A parallel rise in ischaemic heart disease (IHD) is also projected. Other developing countries will be similarly affected.

Diabetes is increasing in epidemic proportions worldwide. The number of people with diabetes is currently estimated to amount to nearly 180 million in the over 140 IDF member countries. While a relatively large number of studies have so far been carried out into the causes and development of diabetes mellitus in the Caucasian populations, up until recently, data on the aetiology and pathogenesis of the condition in the Asian population was still relatively scarce. The Asian Young Diabetes (ASDIAB) Study, the most significant results of which are revealed below, was intended to fill this gap.

Together with its 'twin sister', childhood obesity, Type 2 diabetes is spreading among young people around the world. This constitutes a serious public health problem; by their 30s, generations of young people will have been living with Type 2

Although the exact magnitude of the problem in Africa is not well understood, diabetes is a serious threat to public health throughout the continent. In 2003, the International Diabetes Federation (IDF) predicted that by 2010, diabetes prevalence in Africa would increase by around 95%. Ignoring diabetes could lead to the breakdown of the fragile health systems in Africa, which are already overwhelmed by communicable diseases such as tuberculosis, malaria, and HIV/AIDS.

Overweight is an important risk factor for noncommunicable diseases in general and diabetes in particular. There is presently a global epidemic of overweight. A recent large study found a 5.6% growth in obesity in the United States in 2001, and a massive 74% increase since 1991. Twenty one percent of American adults are obese. The prevalence of diabetes, which correlates with obesity has risen 61% in the US since 1990. Diabetes rose 8% over 2000-01 to nearly 8% of the population. The situation is not much better in many developing countries.

Obesity is an epidemic accelerating out of control. It is the driving force behind an equally dramatic explosion of Type 2 diabetes, both in adults and now alarmingly among children. Clearly, strategies aimed at improving the prevention and management of obesity must be developed. Not confined to affluent nations, the obesity epidemic imposes a double burden on countries where people are still struggling to overcome generations of chronic undernutrition. Economic progress in developing countries heralds changes in