If diabetes was a country, it would be the world’s third largest nation (by population) after China and India, says Monash University, Australia, professor of diabetes Dr Paul Zimmet.
In 2015, China had an estimated population of around 1.37 billion people and India around 1.26 billion, followed by the United States with just over 320 million people.
Meanwhile, the International Diabetes Federation (IDF) estimated that there were 415 million people living with diabetes around the world in the same year.
A further 318 million people had impaired glucose tolerance or pre-diabetes – the stage directly before full-blown type 2 diabetes mellitus.
The umbrella organisation for over 230 national diabetes associations also estimates that there will be 642 million, or one in every 10, people with diabetes by 2030.
More scary is the fact that Prof Zimmet, an IDF honorary president, believes that this number is an underestimation due to the lack of accurate data.
For example, he notes that the standard diagnostic fasting blood glucose test misses up to 25% of diabetes cases, if it is not paired with the oral glucose tolerance test. (See Screening for diabetes on p2)
And for countries that do not record diabetes data, extrapolations from the data of other similar countries are used instead.
For example, Prof Zimmet shares that the diabetes data for Eritrea, one of the world’s poorest nations, is extrapolated from South Africa’s and Tanzania’s diabetic numbers.
Prof Zimmet says that diabetes is an epidemic that is still on the rise, which will result in more and more premature
deaths and disabilities among those of working age.
deaths and disabilities among those of working age.
He compliments Malaysia on the way diabetes data is recorded in the country.
“There aren’t too many countries that actually keep as good data on diabetes as Malaysia,” he says.
“So the Government has got all the information it needs to do something.”
In the July edition of the journal Nature Reviews Endocrinology, Prof Zimmet and his colleagues wrote that accurate and reliable data is necessary in “meeting national and local needs for planning purposes to identify current and future healthcare priorities, to estimate direct and indirect economic and societal costs of the disease, and to allocate appropriate healthcare resources and expenditures for healthcare delivery.
“These data are also very important for identifying groups or populations that might have unique or special needs related to diabetes mellitus, and to help define and set research priorities.
“Ongoing reliable data are also needed not only to project future trends, but to monitor the effects of treatment and to determine the needs, plans, design and effectiveness of prevention activities.”
Lesser-known risks
Diabetes is a simple enough disease in itself; basically, the body is unable to process glucose properly, resulting in high levels of glucose floating around the bloodstream.
The problem is that this excess glucose has wide-ranging effects on multiple body parts.
Common complications of diabetes include retinopathy (eye damage), nephro- pathy (kidney damage), neuropathy (nerve damage) and cardiovascular disease.
Prof Zimmet notes that diabetes is the leading cause of blindness (from retinopathy), kidney disease (from nephropathy) and non-traumatic lower limb amputation (from neuropathy) in the world. It also causes a significant number of heart attacks and strokes.
However, he says that diabetes also has other lesser known complications that simi- larly have a significant effect on people’s lives, as well as economic productivity.
“Data from various countries suggests that people with type 2 diabetes are more likely to have sleep apnoea – 30%-40% will have sleep disturbances.
“And if they go to sleep on the job in a factory, they will lose their fingers. If they are driving a car, they will have car accidents. If they are truck drivers and they go to sleep on the highway, they can clean up about six or seven cars.
“That’s a big public health problem associated with diabetes, quite apart from the complications,” he explains.
Thirty to forty percent of type 2 diabetics suffer from sleep apnoea, which results in sleepiness during the day.
Sleep apnoea is a disorder where the person suffers from either one or more pauses in breathing or shallow breaths during sleep, which can last from a few seconds to mi- nutes.
Each pause or shallow breath disrupts the person’s sleep, resulting in poor quality sleep that causes the person to be tired and sleepy during the day.
Prof Zimmet says however, that the connection between diabetes and sleep apnoea is still unknown; researchers only know that the two are associated.
He adds: “The other thing that is a big problem with diabetes is that, certainly in Western countries, 30%-40% of type 2 diabe- tics have depression – that’s another public health problem.
“And people with poorly-controlled diabetes get a lot of fat in their liver.”
Fatty liver occurs when more than 5%-10% of the liver’s weight is fat. This can eventually led to cirrhosis of the liver, which may result in liver failure or liver cancer.
Says Prof Zimmet: “The commonest cause of cirrhosis at the moment is alcohol, but they are now predicting cirrhosis of the liver, in the next decade or so, is going to be from diabetes.”
He adds: “There is a very simplistic view that it’s just all about high blood sugar and complications that we know about, which are amputations, blindness, heart attacks and kidney disease.
“But people don’t link in all the factors, not only sleep apnoea, depression and cirrhosis, but people die younger – we’re now seeing people develop type 2 diabetes in childhood – and the fact that the complications of diabetes can have an economic impact on the country, because we’re seeing type 2 diabetes in the working age group now.
“And so, there’s premature deaths and disabilities from diabetes, it’s not just a simple high blood sugar.”
He concludes: “Diabetes is complicated. It doesn’t just have complications; overall, it is a complicated disease.”
Prof Zimmet was in town recently to give a talk on “Diabesity – The Greatest Epidemic in Human History? Implications for Asia” in Sunway University, Selangor, as part of the Jeffrey Cheah Distinguished Speakers Series.
