Developing countries

As prevalence of diabetes increases globally, developing countries such as India face the massive burden of a diabetes epidemic in the urban population. Migrant Asians from the Indian subcontinent are known to have a higher prevalence of Type 2 diabetes than the host populations and other migrant ethnic groups. Studies conducted in several Asian countries in the last decade highlighted a rising prevalence of Type 2 diabetes in the urban population. The prevalence of impaired glucose tolerance (IGT) is also on the rise, indicating a possible further increase in diabetes in the future.

Were there warnings that diabetes would become the epidemic of the 21st century? In the early 1970s, Peter Bennett and co-workers reported on the extraordinarily high prevalence of Type 2 diabetes in Pima Native Americans. In 1975, we reported the high rates of diabetes in the Micronesian Nauruans in the Pacific. Similar findings followed in other Pacific and Asian island populations. They all indicated the potential for a future global epidemic.

Even among policy makers at an international and national level, awareness about the public health and clinical importance of diabetes remains low. Diabetes is widely perceived as a condition of low importance to the poorer populations in the world. In the low- and middle-income countries, the impact of diabetes is largely unrecognized. Yet the world is facing a dramatic rise in diabetes prevalence, most of which will occur in the low- and middle-income countries.

Pakistan is a South-Asian country with a population of approximately 150 million. Diabetes prevalence in Pakistan is high: 12% of people above 25 years of age suffer from the condition and 10% have impaired glucose tolerance (IGT). When one considers the associated risk factors present in Pakistani society, the large number of people with diabetes is no surprise. Obesity tops the list.

The World Diabetes Foundation (WDF) is dedicated to supporting prevention and management of diabetes in the developing world. Accordingly it funds sustainable projects in education, capacity building, and distribution and procurement of essential medical supplies. WDF creates partnerships and acts as a catalyst to help others

Diabetes-related foot infections are a scourge all over the world. People suffer such infections when the skin of the foot breaks down secondary to peripheral nerve damage – one of the complications of diabetes. High blood sugar (hyperglycaemia) impairs a person's defences to infection. In poorly controlled diabetes in particular, infection can occur abruptly and spread rapidly. It is not so well-known that similar infections can occur in the hand. Globally, this is much less common than foot infection. However, it is a significant problem, particularly in the tropics.

India is fast-becoming the diabetes capital of the world. More than 35.5 million people in India now have diabetes. This figure is likely to rise to 57 million by 2025. This increase, principally in people with Type 2 diabetes, is bringing with it a sharp growth in diabetic complications, including eye disease (retinopathy) and kidney disease (nephropathy). In this report, Ambady Ramachandran describes the costs of diabetes and kidney disease to a person in India

A rising frequency of diabetic kidney disease worldwide is disproportionately affecting disadvantaged people. Among the hardest hit are people in the poorest countries, which lack the public health infrastructure to address the epidemic using treatments widely available in the developed world. In this article, Robert Nelson examines the frequency of diabetic kidney disease in various parts of the world, explores some reasons why disadvantaged populations may be particularly vulnerable to this complication of diabetes, and describes how health-care providers may successfully

In 1996, American Youth Understanding Diabetes Abroad (AYUDA) was set up by two teenagers after they had witnessed the economic and emotional hardships faced by José Gabriel and other young people living with diabetes in Latin America.They envisioned a youth-led organization that would educate young people with diabetes about diabetes issues, and help empower them to work effectively for positive change. AYUDA is now a growing organization, which campaigns to raise diabetes awareness and promote sustainable development for diabetes communities throughout the world.

Tunisia, like most countries of the world, is experiencing an alarming rise in the number of people with diabetes: the prevalence of Type 2 diabetes in adults over 30 year of age rose from 4.2% in 1976 to 10% in 1995. In response, the Tunisian Ministry of Public Health have developed a National Programme of diabetes and high blood pressure (hypertension) management in primary care. Initially introduced in 1993, the Programme was then implemented throughout the country in 1998.