World Diabetes Day happens every year on Nov 14. It marks the birthday of Frederick Banting, who, along with Charles Best, had the idea that the pancreas’ internal secretion, which regulates blood sugar, might hold the key to the treatment of diabetes. They were right, and insulin was discovered in 1922.
World Diabetes Day was launched in 1991 by the International Diabetes Federation (IDF) and WHO in response to concerns about the escalating health threat from diabetes. Each year a new theme is chosen by the IDF to address issues facing the global diabetes community. The campaign slogan for 2010 is “Let’s take control of diabetes. Now”.
A recent report from the UK’s Quality and Outcomes Framework (QOF) Exception Data 2009/10 includes information on the incidence and prevalence of type 2 diabetes and obesity. Figures were collected through general practices and show that the population with obesity has risen by more than 265 000 to 5·5 million in the UK over the past year. Also, the number of
people diagnosed with type 2 diabetes in the UK increased by more than 150 000 to 2·8 million in 2009–10. One in 20 of the population is being treated for diabetes, and one in ten for obesity. Around 10% of National Health Service spending goes on diabetes and its complications—equivalent to £9 billion per year or £1 million per hour. “The obesity-fuelled type 2 diabetes epidemic is a clear example of where the new Coalition Government’s rhetoric of tackling health
problems through prevention must be turned into action”, says Simon O’Neil, Diabetes UK’s director of care, information, and advocacy. Guidance suggests that people must keep up their consumption of fi ve portions of fruit and vegetables a day, engage in daily physical activity, and be provided with prominent and regular warnings of the potentially devastating consequences of an unhealthy lifestyle.
The situation in the USA is much worse. In 2007, the combined costs of types 1 and 2 diabetes
were over US$174 billion. The National Diabetes Surveillance System of the Centers for Disease
Control and Prevention (CDC) has estimated that the future prevalence of diagnosed diabetes could be substantially worse than that previously suggested. A large increase in diabetes prevalence could be driven by multiple factors, including increased incidence, better detection, and greater incidence and prevalence among immigrant populations. The prevalence of total
diabetes (diagnosed and undiagnosed) in the USA is forecast to increase from its current level of about one in ten adults to between one in fi ve and one in three adults by 2050. The health-care costs of a person with diagnosed diabetes are about 2·3 times higher than a person without diabetes. Additionally, the CDC’s model makes the brave assumption that the mortality rate of the diabetic population will decline at least as much as that of the non-diabetic population as healthcare outcomes improve over time (ie, the mortality rate ratio associated with diabetes will be constant). This estimate might well be too optimistic.
The data published in the UK and USA did not consider people aged under 18 years. But a report
by Australia’s Productivity Commission found that many schemes to prevent childhood obesity, which is a risk factor for type 2 diabetes, failed to make a substantial impact among young people in Australia. The latest figures show that the rate of obesity in boys aged up to 17 years has risen dramatically in the past two decades to 10%, with a further 16% deemed overweight. The rise in prevalence of obesity in girls has levelled off at about 5%, with about 18% deemed overweight. Obesity cost the Australian Goverment Aus$58·2 billion in 2008, according to Diabetes
Australia, which comprised Aus$8·3 billion of financial costs and Aus$49·9 billion in lost wellbeing—due to disability or shorter life span. The report concluded that the most cost-eff ective interventions for obesity prevention were a 10% tax on junk food, restricting unhealthy food advertising to children, and the labelling of food packaging with a traffi c-light system.
As the health risks of obesity and diabetes multiply across developing countries, deaths from diabetes are likely to increase by more than 50% over the next 10 years without urgent action. Governments everywhere must act now to tackle this global public health issue. Preventive public health policies need to be designed and implemented based on costeff ectiveness, with a focus on gathering evidence, information sharing, evaluation, and continuing policy refinement. ■ The Lancet
