by Henrylito D. Tacio
The number of cases of diabetes in developing countries, including the Philippines, is likely to increase more than two-fold in the next 30 years, according to the World Health Organization (WHO).
“Diabetes is part of the growing epidemic of non-communicable diseases that are beginning to impose a double burden of disease on the world’s poorest countries,” deplored Dr Catherine Le Galès-Camus, WHO Assistant Director-General, Non-communicable Diseases and Mental Health.
In 2000, there were 115 million diabetics. By 2030, the figure will go up to 284 million. The burden of disease associated with diabetes is substantial. At least one in 20 deaths around the world is attributed to diabetes. In financial terms, direct health care costs range from 2.5 percent to 15 percent of annual health care budgets, and indirect costs such as loss of production may be five times this number.
Diabetes is one of the 21st century’s most challenging health problems. The disease is spreading more rapidly in Asia than anywhere else. In the Philippines, for instance, there are about four million diabetics, with more than three million not knowing they have it. Out of the one million who know they have the disease, only 200,000 are undergoing treatment.
“There’s a potential time bomb here in numbers of people who are going to develop the complications of diabetes,” points out an official of the Novo Nordisk, a diabetes care company. “Only a few are diagnosed and treated due to inaccessibility to health care and medication, lack of government spending on health care, meaning patients have to provide for their own medication and education. But even in countries where there’s free medication and access to health care, the control of diabetes is not a lot better than in the Philippines because something is wrong in the education aspect.”
Diabetes mellitus (its complete name) is a chronic, debilitating and often deadly disease that affects how the body turns food into energy. Normally, the food we eat is converted into glucose and used or stored by the body with little problems. Circulating insulin hormone stimulates the uptake of sugar by the body’s cells. But with diabetes something goes awry. The pancreas, which is the organ responsible for producing insulin, becomes irresponsible.
Diabetes strikes in two forms. Type 1, in which the body does not make enough insulin, generally afflicts children and adolescents; Type 2 is much more widespread and most often strikes in adulthood. Type 2 diabetes are either unable to produce enough insulin, or, if they do churn out enough, are unable to process and utilize it properly.
Some 90% of the world’s estimated 171 million people with diabetes have Type 2 diabetes. This used to be considered a disease of older people and rich countries.
Unlike certain crippling diseases, which attack without warning, diabetes sends out warnings by displaying symptoms. Medical scientists list the following: frequent urination and great thirst; weight loss and extreme
hunger; weakness and tiredness; and skin problems. Other symptoms include nausea and vomiting, blurred vision, drowsiness, cramps or numbness in the toes and fingers, and abdominal pain.
“Many Filipinos simply don’t know they have the disease,” says Dr. Augusto Litonjua, one of the country’s leading experts on diabetes. “We cannot win the war against diabetes if we do not know the enemy,” says the Philippine Center for Diabetes Education Foundation in a statement.
For instance, diabetes tends to run in the family. “Diabetes is a hereditary disease passed on from generation to generation,” said Dr. Alberto Romualdez, when he was still the health secretary. “When there is a diabetic in the family, no matter how distant a relative the patient is, the characteristic is still passed on through the genes. If both parents have diabetes, the offspring’s chance of developing the disease is greater. It is very important therefore that everyone in a family with a diabetic member must prepare early to prevent the onset of the disease.”
According to health experts, the symptoms of diabetes are excessive thirst and appetite; increased urination (sometimes as often as every hour); weight loss; fatigue; nausea, perhaps vomiting; and blurred vision. In women, there are frequent vaginal infections and perhaps the cessation of menstruation.
Long-term complications of diabetes can damage the eyes, kidneys, nervous system, and cardiovascular systems, as well as hinder the body’s overall resistance to infections. Cuts and sores heal more slowly for people with diabetes, and diabetics are also prone to gum problems, urinary tract infections, and mouth infections such as thrush, caused by overgrowth of yeast organisms.
In the Philippines, about 50-55 percent of people with diabetes develop kidney disease. The Philippine Society of Nephrology said diabetes is the single most common cause of kidney failure, with 31 percent of the 4,409 patients who underwent chemodialysis having diabetes mellitus nephropathy, a primary renal disease.
“The government and private sector have to work double-time to at least halt the increase in the rate of incidence of diabetes, if not reduce it significantly,” urged Dr. Litonjua.
Meanwhile, the projected increase in diabetes worldwide by 2030 can still be curtailed through attention to diet and physical activity, according to Dr. Le Galès-Camus.
“For those who have diabetes, good management of the disease can delay or even prevent complications and disability. Promoting self-management by patients, proactive control of risk factors by health professionals and reorganization of health services to manage chronic conditions have all been shown to make a significant difference to patients”, said Dr Rafael Bengoa, the director of the WHO Management of Non-communicable Diseases.
“We will be working with countries to find ways to deliver a minimum package of care in even the poorest settings. Prevention and management go hand in hand.”
Dr Le Galès-Camus believes that the lifestyles of people around the world are changing. “We are less active than our parents and grandparents, and we eat food with higher concentrations of sugars and fats, often with the result that we are putting on weight, and increasing the risk of diabetes.
Add to this the fact that populations are ageing, and it is easy to see why diseases such as diabetes are on the increase.”
The WHO official cites China as a graphic example. Diabetes is already a substantial concern, with 21 million cases in the year 2000, or one in every 60 people. Obesity is on the rise – a recent study showed that even among Chinese pre-school children, obesity rates increased tenfold to affect one in every 10 children over an eight-year period. “This extra weight increases their risk of diabetes as they grow older,” she surmises. — ###