Key messages 2009
Understand Diabetes and Take Control
Diabetes currently affects more than 250 million people worldwide. A further 300 million are at high risk of developing diabetes. The International Diabetes Federation predicts that by 2025, over 380 million people will live with diabetes worldwide. Over the past 30 years the global figures for the number of people living with diabetes have skyrocketed, with severe consequences for healthcare budgets worldwide. Diabetes is one of several non-communicable diseases that threaten to overwhelm healthcare systems and are emerging as a serious barrier to economic development.

The World Diabetes Day campaign's key messages are:
•Know the diabetes risks and know the warning signs
•Know how to respond to diabetes and who to turn to
•Know how to manage diabetes and take control

Did you know?
•Every 10 seconds a person dies from diabetes-related causes.
•Every 10 seconds two people develop diabetes.
•Each year a further 7 million people develop diabetes
•Diabetes is the fourth leading cause of global death by disease.
•Each year 3.8 million deaths are attributable to diabetes
•All diabetes is on the rise
•Diabetes affects people of all ages
•Care for people with diabetes is best when a multidisciplinary approach is adopted involving health professionals from all areas
•Access to appropriate medication and care should be a right not a privilege
•Diabetes costs more than money
•Over 50% of type 2 diabetes can be prevented
•Diabetes brings different challenges at different ages
•Diabetes hits the poorest hardest.

The World Diabetes Day campaign 2009-2013 aims to:
•Encourage governments to implement and strengthen policies for the prevention and control of diabetes and its complications.
•Disseminate tools to support national and local initiatives for the prevention and management of diabetes and its complications.
•Illustrate the importance of evidence-based education in the prevention and management of diabetes and its complications.
•Raise awareness of the warning signs of diabetes and promote action to encourage early diagnosis.
•Raise awareness of and promote action to reduce the main modifiable risk factors for type 2 diabetes.
•Raise awareness and promote action to prevent or delay the complications of diabetes.

What is diabetes?
Diabetes is a chronic, potentially debilitating and often fatal disease. The disease occurs as a result of problems with the production and supply of insulin in the body. Either the body produces no or insufficient insulin (type 1 diabetes), or the body cannot use the insulin it produces effectively (type 2 diabetes). Insulin is a hormone made by the pancreas that helps ‘sugar’ (glucose) to leave the blood and enter the cells of the body to be used as ‘fuel’.

Two types of diabetes
There are two main types of diabetes:

Type 1 diabetes is sometimes called insulin-dependent, immune-mediated or juvenile-onset diabetes. It is caused by an auto-immune reaction where the body’s defence system attacks the insulin-producing cells. The reason why this occurs is not fully understood. People with type 1 diabetes produce very little or no insulin. The disease can affect people of any age, but usually occurs in children or young adults. People with this form of diabetes need injections of insulin every day in order to control the levels of glucose in their blood. If people with type 1 diabetes do not have access to insulin, they die.

Type 2 diabetes is sometimes called non-insulin dependent diabetes or adult-onset diabetes. People with type 2 diabetes do not usually require injections of insulin. Usually, they can control the glucose in their blood by watching their diet, taking regular exercise, oral medication, and possibly insulin. Type 2 diabetes is most common in people older than 45 who are overweight. However, as a consequence of increased obesity among the young, it is becoming more common in children and young adults. Type 2 diabetes is the most common type of diabetes and accounts for 90-95% of all diabetes.

If people with type 2 diabetes are not diagnosed and treated, they can develop serious complications, which can result in an early death. Worldwide, many millions of people have type 2 diabetes without even knowing it. Others do not have access to adequate medical care. The onset of type 2 diabetes is also linked to genetic factors but obesity, physical inactivity and unhealthy diet increase the risks. Some women develop a third, usually temporary, type of diabetes called ‘gestational diabetes’ when they are pregnant. Gestational diabetes develops in 2-5% of all pregnancies, but usually disappears when the pregnancy is over. Women who have had gestational diabetes have an increased risk of developing type 2 diabetes later on.

Impaired Glucose Tolerance (IGT)
People with impaired glucose tolerance (IGT) have glucose levels that are above normal but below the level at which diabetes is diagnosed. People with IGT have a significant risk of developing type 2 diabetes. They are thus an important target group for primary prevention. Changes in lifestyle, including diet and physical activity can greatly reduce the onset of diabetes.

Recognizing diabetes
The onset of type 1 diabetes is often sudden and dramatic and can include symptoms such as:

Abnormal thirst and a dry mouth
Frequent urination
Extreme tiredness/lack of energy
Constant hunger
Sudden weight loss
Slow-healing wounds
Recurrent infections
Blurred vision

The same symptoms that are listed above can also affect people with type 2 diabetes, but usually the symptoms are less obvious. The onset of type 2 diabetes is gradual and therefore hard to detect. Indeed, some people with type 2 diabetes show no obvious symptoms early on. These people are often diagnosed several years later, when various complications are already present.

Life-threatening complications
Without proper insulin production and action, glucose remains in the blood, leading to chronic hyperglycaemia (raised blood sugar). This can result in short and long-term complications, many of which, if not prevented and left untreated, can be fatal. All have the potential to reduce the quality of life of people with diabetes and their families. The most common long-term complications are: Diabetic nephropathy (kidney disease), which may result in total kidney failure and in the need for dialysis or kidney transplant.

Diabetic eye disease (retinopathy and macular oedema), damage to the retina of the eye which can lead to vision loss. Diabetic neuropathy (nerve disease), which can ultimately lead to ulceration and amputation of the feet and lower limbs. Cardiovascular disease, which affects the heart and blood vessels and may cause fatal complications such as coronary heart disease (leading to a heart attack) and stroke. Diabetes is the fourth leading cause of death by disease globally. Every year, 3.8 million people die from diabetes-related causes.

10 Misconceptions about Diabetes
1. Diabetes is not a killer disease – False!
In fact, diabetes is a global killer, rivalling HIV/AIDS in its deadly reach. The disease kills some 3.8 million people a year. Every 10 seconds a person dies from diabetes-related causes.

2. Diabetes only affects rich countries – False!
Diabetes hits all populations, regardless of income. It is becoming increasingly common. More than 240 million people worldwide now have diabetes. This will grow to more than 380 million by 2025. In many countries in Asia, the Middle East, Oceania and the Caribbean, diabetes affects 12-20% of the population. In 2025, 80% of all cases of diabetes will be in low and middle-income countries.

3. Diabetes is heavily funded globally – False!
Offi cial Overseas Development Aid to the health sector in 2002 reached USD 2.9 billion, of which a mere 0.1% went to fund ALL non-communicable chronic diseases (NCDs). Most of the USD 2.9 billion went to support HIV/AIDS. Despite diabetes having a deadly global impact comparable to HIV/AIDS, it had to share the tiny 0.1% of the total NCD funding. In addition, the World Bank gave USD 4.2 billion in loans for health, population and nutrition between 1997 and 2002. Only 2.5% of the USD 4.2 billion went to chronic diseases.

4. Diabetes care is not costly – False!
Diabetes care is costly and has the potential to cripple any healthcare system. The economic opportunities that the United Nations wants to create for developing countries through the Millennium Development Goals will be greatly undermined by the economic impact of diabetes in low- and middle-income countries.

5. Diabetes only affects old people – False!
In reality, diabetes affects all age groups. Currently, an estimated 246 million people between the ages of 20 and 79 will have diabetes. In developing countries diabetes affects at least 80 million people between ages 40-59.

6. Diabetes predominantly affects men – False!
In fact, diabetes is rising in both men and women, and affects slightly more women than men. It is also increasing dramatically among youth and threatening to decimate indigenous populations.

7. Diabetes is the result of unhealthy “lifestyles” – False!
The reality is that the poor and children have limited choices when it comes to living conditions, diet and education.

8. Diabetes cannot be prevented – False!
While it is true that type 1 diabetes is not preventable, up to 80% of type 2 diabetes is preventable by a healthy diet, increasing physical activity and promoting a healthy lifestyle.

9. Diabetes prevention is too expensive – False!
Many inexpensive and cost-effective interventions exist. Proven strategies for improving the living environment, changing diet and increasing physical activity can reverse the pandemic.

10. We all have to die of something – True but. . .
Death is of course inevitable but it does not need to be slow, painful or premature. Diabetes causes 3.8 million deaths globally. With awareness, prevention and appropriate care, many of these deaths can be prevented.

References
The idea for ‘10 misconceptions about diabetes’ is based on the World Health Organization’s
global report: ‘Preventing chronic diseases: a vital investment’, which presents 10 common
misunderstandings about chronic diseases. The data comes from various sources, including:
Roglic G et al: The Burden of Mortality Attributable to Diabetes: Realistic estimates for the
year 2000. Diabetes Care 28: 2130-2135. The Diabetes Atlas 3rd Edition, International Diabetes
Federation, 2006. Yach D et al: The global burden of chronic diseases. JAMA 2004).

The Economics of Diabetes: Human and Social Effects
The global diabetes epidemic has devastating personal and social effects, far greater than most people imagine. Surprisingly, the highest costs of diabetes are not the hundreds of billions spent on complications that could have been prevented, although these expenditures are large, but the suffering imposed on families (death, disability and economic stress) and the resulting large annual losses in economic growth that harm everyone. Diabetes harms all people in society, not just those who live with diabetes.

From an economic point of view, these effects are tragic because proven, low-cost treatments are available to prevent most of them. Even in the poorest countries, many of these treatments would actually save medical care expenditures.

Death and disability
Diabetes is expected to cause 3.8 million deaths worldwide in 2007, roughly 6% of total world mortality, about the same as HIV/AIDS and malaria combined. Using World Health Organization (WHO) fi gures on years of life lost per person dying of diabetes, this translates into more than 25 million years of lost life each year.

The International Diabetes Federation (IDF) estimates that the equivalent of an additional 23 million years of life are lost each year to the disability and reduced quality of life caused by diabetes complications.

Losses to mortality and disability are particularly high in poor and middle-income countries, where people with diabetes are unlikely to get the treatments that are proven to prevent the disease’s killing and disabling complications. For example, in sub-Saharan Africa mortality from diabetes is four times higher than the world average. In these locations, children with type 1 diabetes often die because governments do not ensure that insulin is available and affordable. Instead, many governments tax insulin at their borders, and prevent low-cost generic insulin from being sold. A recent comparison of three otherwise similar African countries showed the consequences. In Zambia, which has a program for insulin management, a person requiring insulin for survival can expect to live an average of 11 years. In Mali, the same person can expect to live for only 30 months, while in Mozambique that person will be dead within a year.

Needless deaths in children are tragic and affecting. Statistically, however, diabetes causes nearly all its death and disability in adults. As a result, many children’s lives are adversely affected by a diabetes-related death or disability in the family. This can mean that children must abandon education to supplement the household income or help care for an ailing relative. The economic impact of diabetes on the family can leave no money to pay for children’s medicine and schooling.

Better treatment can save money everywhere
The costly and fatal effects of diabetes arise largely from its complications, especially heart disease, stroke, amputation and kidney failure. These can be prevented or long-delayed by inexpensive, off-patent pills to control blood sugar, blood pressure, and bad cholesterol (which together reduce risks by more than half); by low-dose aspirin to reduce heart disease risk by 20 25 percent; by stopping smoking (the most important ‘treatment’ of all), and by adopting a healthy diet and exercise. The most effective way to prevent diabetes is by losing weight and getting exercise, but some pills also delay diabetes.

In 2006, the World Bank systematically assessed the cost-effectiveness and feasibility of diabetes interventions in developing countries. They identifi ed 14 life-saving treatments that would be cost-effective in every developing region of the world, including four that would actually save money for everyone. The four cost-saving treatments are simple, minimal control of high blood sugar and high blood pressure, foot care in people at high risk of ulcers, and preconception care for women with diabetes. Subsequent research would add a daily aspirin and possibly a daily statin drug to this list. These diabetes treatments are not only inexpensive and cost-saving, they are straightforward to distribute and easy for patients to take. Side-effects are rare at proposed dosages. Regular monitoring is not essential. The pills are almost too inexpensive to be worth the risk of counterfeiting. And treatments like these fl ow easily through a country’s existing, locally governed healthcare infrastructure, strengthening the core institutions on which every nation’s health ultimately depends.