WASHINGTON, July 18 (UPI) -- Along with high-calorie diets and sedentary lifestyles, the ways of the West are leaving people in developing countries with an insidious legacy: diabetes.
Globally, nearly 6 percent of the world's adult population, or more than 230 million people, now have diabetes, according to data released in June by the International Diabetes Federation, a nonprofit organization based in Brussels. If left unchecked, scientists expect the rate to climb to 350 million people in less than 20 years -- and more than 80 percent of these cases will occur in the developing world.
"The facts of the epidemic cannot be denied," said Martin Silink, president-elect of the IDF. "We're asking for governments to recognize this incredible epidemic ... a whole government approach is the only thing that will turn this around."
Complications from type-2 diabetes, a disease in which the body becomes resistant to the hormone insulin, leads to a human death every 10 seconds -- ranking it alongside HIV/AIDS as a worldwide scourge, Silink says.
The five countries with the largest numbers of people with diabetes are India (35.5 million), China (23.8 million), the United States (16 million), Russia (9.7 million) and Japan (6.7 million), according to 2003 data from the IDF, the most recent published statistics on the countries available.
By 2025 the number of people with diabetes is expected to more than double in Africa, the Eastern Mediterranean and Middle East, and Southeast Asia, according to the group.
The two other types of diabetes, type-1, also known as juvenile-onset diabetes; and gestational, are not rising as quickly as type-2 diabetes, often associated with lifestyle choices.
The IDF and other organizations recently launched the Unite for Diabetes campaign to rally for a United Nations Resolution on Diabetes, which would bring attention to the disease and ask that November 14 be observed as "World Diabetes Day," already informally recognized. Ninety-six member countries need to vote for the resolution for it to become official; campaign organizers are hoping for this to happen before November 2007.
If passed, the U.N. resolution would be the first to address a chronic, non-communicable disease; historically, diabetes has been overshadowed in both aid and attention by the heavy-hitters of global health, such as HIV/AIDS and tuberculosis.
"(The resolution) gives us a platform of legitimacy for raising the profile of diabetes," says Clare Rosenfeld, 20, a diabetes advocate. Rosenfeld, who created the idea of the Unite for Diabetes campaign in 2001, was diagnosed with type-1 diabetes at 7. Now a student at Lewis and Clark College in Portland, Ore., she has been lobbying for diabetes care and prevention for more than a decade.
Although a U.N. resolution would lack a specific mandate, it would likely boost grassroots efforts now struggling to get on their feet, Rosenfeld says.
Dr. Kaushik Ramaiya, the Dar-es-Salaam, Tanzania-based chairman of the IDF's Africa Region, agreed, adding U.N. recognition could bring about better diabetes management in sub-Saharan Africa.
In Tanzania 300,000 to 350,000 of the country's 32 million people have diabetes, according to a 2005 article by Ramaiya in the British Medical Journal.
Currently, healthcare providers in Africa rank diabetes low on their priority list, as major infectious diseases consume the bulk of their resources. But ignoring diabetes may precipitate a spike in healthcare costs in coming years, not to mention a crippling of an already-fragile healthcare system in southern Africa, Ramaiya told United Press International in a phone interview.
In 2007, the world will likely spend between $215 billion and $375 billion on the medical care costs of diabetes and its complications, according to the IDF. Complications associated with diabetes include heart disease and stroke, kidney disease and blindness.
"(Diabetes) is still a problem that needs to be highlighted," Ramaiya said.
Unlike malaria, which is spread by a single vector -- the mosquito -- diabetes is a more complex byproduct of industrialization. Experts agree the worldwide trend toward Western-style development, which includes eating high-calorie, energy-dense foods, exercising less and moving into cities -- has abetted diabetes growth.
So has the genetic proclivity of several minorities to develop the disease.
Many Africans, for example, are genetically programmed to put on weight in the abdominal area, which increases the risk for diabetes dramatically, Silink said. An African or Asian man of average weight and who looks otherwise healthy could be a diabetic.
"It's a myth that only obese people are at risk for diabetes," Silink said.
Diabetes has also been striking people earlier in life. Usually, type-2 develops in adults older than 50. In recent years, however, doctors are seeing type-2 in kids, who are often overweight and non-active.
Women of childbearing age are particularly in danger. A pregnant woman with type-2 diabetes and high blood sugar levels has more than a 12 percent risk of having a child with birth defects. (If the woman's glucose level is controlled before conception, the risk falls substantially.)
Of the millions of people who have diabetes, about half don't realize they have it. Others are convinced it couldn't happen to them.
Dr. Larry Deeb, president-elect of the American Diabetes Association, remembers treating a Nigerian family at his practice who had recently immigrated to the United States. The parents insisted their obese children were not at risk of diabetes, since it did not run in the family. When Deeb probed further, he learned mom and dad had walked at least 10 miles everyday in Nigeria -- exercise that had likely spared them from the disease.
That's why experts agree exercising to lose a moderate amount of weight can have huge benefits. Studies have shown a 15-pound weight loss, accompanied by 25-minute walks five days a week, could cut a person's risk for diabetes by 58 percent, said Dr. Richard Hellman, president-elect of the American Association of Clinical Endocrinologists.
Yet many people don't realize the control they have over their health.
"There are probably few chronic diseases where so much can be done by the person themselves," Hellman said.
Likewise, basic healthcare can also offset some of the more debilitating consequences of diabetes -- such as foot amputation -- which now occurs once every 30 seconds.
"We're not talking rocket science, we're talking simple foot care," Silink said.
These easy procedures -- for example, rapid treatment of foot ulcers -- could halve the amputation rate worldwide. Some foot care clinics have already sprung up in India and Brazil.
Also, many of the medications for high blood pressure, a condition which often goes hand-in-hand with diabetes, are cheap and easily available to people in the developing world.
But getting at prevention is a more challenging prospect, experts acknowledge. Introducing exercise back into schools, reopening community markets with fruits and vegetables and calling for every new building to have a "health impact statement" are all possible solutions, Silink said.
Because only a few nations have resources and access to the appropriate healthcare for diabetes -- called standard care -- the IDF has developed diabetes care guidelines for people in countries where only minimal care is available.
Recommendations for minimal care situations include aiming diabetes detection programs toward those who are at high-risk, as well as testing for glycosuria -- the presence of glucose in the urine -- if a preferable blood glucose test is not available.
Such innovative solutions are sorely needed, as predictions for diabetes prevalence continue to fall short of reality, said Deeb of the ADA. For instance, the U.S. diabetes rate was expected to hit 21 million in 2010; the country has already surpassed that number.
"Careful, conservative science underestimates the risk of diabetes year after year," Deeb said. "It's exploding so fast we can't keep up with it."
