Diabetes

Burden of Disease

• 150 million diabetics in 2000
• 220 million diabetics by 2020
• Global epidemic resulting from the spread of the “western lifestyle”

The inexorable spread of the western lifestyle across the world is precipitating a diabetes epidemic. Current worldwide prevalence is estimated at 2.3% (or 150 million people) and the number of diabetics is increasing by 4-5% p.a., implying that there could be over 220 million diabetics in the world by 2020. Diabetes is the most common human endocrine disease and the term covers a group of metabolic disorders whose central feature is elevated blood glucose, or hyperglycemia. Sustained hyperglycemia results in the deterioration of multiple tissue types, particularly vascular tissues, and may eventually lead to kidney failure, cardiovascular disease, leg ulcers, stroke, neuropathy and retinopathy. It is estimated that the direct medical costs of diabetes amount to nearly $92 billion annually in the US alone.

Diabetes can be divided into two main patient types:

• Type 1, or insulin-dependent diabetes mellitus (IDDM), usually appears before or during puberty. It is caused by the auto-immune destruction of insulin-producing pancreatic cells and is treated by insulin injections and dietary control. IDDM is a life-threatening disease but almost all cases are successfully diagnosed and treated in the developed world.

• Type 2, or non-insulin-dependent diabetes mellitus (NIDDM), typically appears after the age of 30. The disease is caused by an inability to secrete sufficient insulin or to respond adequately to it and is treated by dietary control, exercise, oral anti-diabetic drugs and insulin, either alone or in combination. NIDDM is not a life-threatening disease, unless ignored or left untreated in the long term, and 40-50% of all Type 2 diabetics are probably undiagnosed.

The recent increase in prevalence of Type 2 diabetes among younger people, often accompanied by obesity, is a major source of concern for public health authorities as it implies significant increases in long-term healthcare costs. There is no cure for either IDDM or NIDDM and the effective treatment for both types hinges upon the tight regulation of blood glucose levels.