Tag Archives: Diabetes Atlas

Optimism About UN Noncommunicable Disease Summit

The noncommunicable disease community is unlikely to get everything it was hoping for out of the United Nations High-Level Meeting on NCDs next week, but its leading spokesperson is upbeat nonetheless. “Even if nothing happens in New York, the fact that people are aware of diabetes and other noncommunicable diseases … that there will be a political declaration – a political statement – coming out of New York stating that diabetes and other NCDs are serious, is an achievement in itself,” International Diabetes Federation president Jean Claude Mbanya said at the annual meeting of the European Association for the Study of Diabetes.

Dr. Jean Claude Mbanya / Photo by Miriam E. Tucker

The upcoming 5th edition of the IDF Diabetes Atlas, to be released on November 14th – World Diabetes Day – will include the data that there are 366 million people living with diabetes and 4.6 million deaths due to diabetes – one death every 7 seconds – at a cost of $465 billion spent on diabetes care. In contrast, the last IDF Diabetes Atlas, released in 2009, put the prevalence figure at 285 million. “The cost of not doing something about diabetes is more than the benefit,” said Dr. Mbanya, who noted that IDF is releasing those few figures in advance of the UN NCD summit because “We don’t want the world leaders to forget about diabetes, which is the tsunami of the 21st century.”

In the Political Declaration, which will probably not change during the UN meeting, member states have agreed to establishing NCD plans and policies that create partnerships, to reducing salts and sugars and eliminate industrially produced trans fats in all foods, to increase access to affordable, quality-assured medicines and technologies, to strengthen health care systems to include integration of NCD prevention and treatment, and to increase resources for NCDs. The document also contains an agreement to develop a comprehensive global monitoring framework for NCDs in 2012, and a set of voluntary global targets and indicators.

Items that IDF and the NCD Alliance had pushed for that didn’t make it into the Declaration because of opposition based primarily on budgetary concerns included the specific target of a 25% reduction of NCD deaths by 2025, and a requirement for monitoring. “We think we need targets and measurements. What gets measured is what gets done,” Dr. Mbanya commented.

But, the UN summit isn’t the last step. There will be another evaluation in 2014, just in advance of the scheduled 2015 revision of the Millennium Development Goals. Because many countries base funding decisions on the MDGs, inclusion of NCDs there would be another huge step forward, he said.

For now though, “just getting heads of states to hold a summit on NCDs is an achievement in itself. This will be only the second summit on health after [the 2001 summit on HIV/AIDS]. So, we have achieved something. We have attracted the world’s attention.”

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Epidemiology, Family Medicine, Health Policy, IMNG, Internal Medicine, Primary care, Pulmonary Diseases and Sleep Medicine, Uncategorized

Diabetes Doesn’t Spare Sub-Saharan Africa

Contrary to widespread belief, diabetes is not rare in sub-Saharan Africa. In an article included in the June 26th special diabetes issue of the Lancet, Dr. Jean Claude Mbanya and his associates outlined what is currently known about diabetes in that region. The statistics may surprise those who are unfamiliar with modern life there.

Just as in the developed world, lifestyle change brought on by rapid urbanization—decreased physical activity and increased consumption of energy-dense and high-fat diets—is believed to be a major contributor to the rising burden of obesity, diabetes, and cardiovascular disease now being seen even in many historically impoverished nations, wrote Dr. Mbanya, president of the International Diabetes Federation (IDF), and his colleagues.

Blood sugar testing in the Democratic Republic of the Congo / Photo courtesy of the International Diabetes Federation

According to the IDF’s Diabetes Atlas, there are now about 12.1 million adults with diabetes in sub-Saharan Africa. That number is projected to nearly double, to 23.9 million, by 2030. Currently, more than a third of the population of sub-Saharan Africa live in urban areas. That is expected to increase to 45% by 2025. And by 2035, more people are expected to live in urban than rural areas.

While diabetes rates of less than 3% have been reported in rural and some urban communities, frequencies of 3%-10% have been noted in urban populations, comparable with rates in developed countries. In urban parts of Dr. Mbanya’s native Cameroon, for example, the diabetes rate rose from 1.5% in the 1990s to 6.6% in 2003.

In most of sub-Saharan Africa, existing health care systems are typically devoted to “the unfinished agenda” of communicable disease, not to chronic noninfectious conditions. There is no medical insurance or free national health care available in most countries, so patients themselves have to pay. “Thus, when an individual with diabetes cannot afford the cost of drugs, the situation could be fatal,” the authors wrote, also noting that mortality rates attributable to diabetes in sub-Saharan Africa are highest in working-age adults aged 20-39 years.

“Agents such as generic glucose-lowering drugs and antihypertensive treatments should be funded just as drugs for HIV/AIDS are, along with support for delivery mechanisms and chronic disease education and care models,” they recommended.  In addition, “A multidisciplinary, politically driven, and coordinated approach in areas of health, finance, education, sports, and agriculture can contribute to a reversal of the underlying cause of this epidemic.” Indeed, that’s a good prescription for the entire world.

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, Health Policy, IMNG, Infectious Diseases, Internal Medicine, Primary care, Uncategorized

A Global Health Agenda

Jean-Claude Mbanya, M.D., Ph.D.

Dr. Jean Claude Mbanya, photo taken by Miriam E. Tucker

From the World Diabetes Congress, Montreal

“Improving the quality of life for people with diabetes at all levels,” Dr. Jean Claude Mbanya replied when I asked him what his primary goal would be over the next 3 years of his term as president of the International Diabetes Federation.

The steps to achieving that goal, which he outlined in a speech at the World Diabetes Congress, actually target something even broader: A restructuring of the world’s health care priorities to focus more attention on noncommunicable diseases (NCDs).

With sedentary lifestyles and unhealthful diets proliferating everywhere, chronic conditions now pose a greater threat to health than do infectious diseases in many parts of the developing world, said Dr. Mbanya, professor of medicine and endocrinology at the University of Yaounde, Cameroon, and chief of the endocrinology and metabolic diseases unit at Hospital Central in Yaounde.

According to the IDF’s newly released Diabetes Atlas, there are now 285 million people in the world with diabetes, nearly double the 151 million reported in 2000.

Contrary to common belief, most people with diabetes live in low- and middle-income countries rather than the wealthy ones, although the latter is where the vast majority of health care funds are spent. India has the highest number of people with diabetes (51 million), followed by China (42 million), and the United States (27 million). “No country is immune to diabetes,” Dr. Mbanya said.

In 2006, a United Nations Resolution on Diabetes recognized the disease as a threat to global health and economic development. That document is IDF’s mandate, he said.

Next steps include furthering an established alliance with the World Heart Federation and the International Union Against Cancer, which have jointly called for the UN to convene a special session on NCDs. The three health organizations also are urging the UN to incorporate NCD indicators in the 2015 Millennium Development Goals, which currently specify only HIV/AIDS and malaria as diseases that need to be addressed in the name of improving world development.

Indeed, Dr. Mbanya believes that the disproportionate focus on infectious diseases at the expense of NCDs has distorted health funding: The World Health Organization budget for infectious diseases is 10 times more than the amount earmarked for NCDs, mental health, and injuries combined. Money shouldn’t be taken away from infectious disease, he said, but instead health systems should be restructured to “treat the whole person and not compartmentalize treatment by disease.”

By the same token, IDF and other NCD organizations also are calling for essential medicines to treat NCDs—including low-cost, generic drugs that reduce glucose, blood pressure, and lipids—to be made available to poorer countries, just as HIV and malaria drugs are now.

“We have to act today to ensure that accidents of geography and history do not determine who should live and who should die,” the new IDF president said.

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Infectious Diseases