Health and Healthcare

Diabetes is a fast-growing disease of the poor. Here’s how we can turn the tide

Client Viola Sanon has her finger pricked for a blood sugar test in the Family Van in Boston, Massachusetts, August 9, 2010.  Every week, dozens of residents of this low-income Boston neighborhood stop into the Family Van, an RV manned by healthcare workers affiliated with Harvard Medical School who perform simple, free screenings, including blood pressure, body mass index and blood sugar, which can alert patients if they face an elevated risk for diabetes, hypertension or other chronic conditions.   REUTERS/Brian Snyder    (UNITED STATES - Tags: HEALTH SOCIETY) - GM1E68A0HLP01

Out of 400 million people with diabetes worldwide, over 300 million live in developing countries. Image: REUTERS/Brian Snyder

Bent Lautrup-Nielsen
Senior Programme Manager, World Diabetes Foundation
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For many years, diabetes was considered a ‘disease of the rich’, mostly found among elderly people in developed countries. Diabetes was never part of any development programme, nor was it given much attention by governments or healthcare providers in developing countries.

It was almost impossible to find a diabetes clinic in Tanzania or a doctor or nurse trained in diabetes care in Bangladesh. If you were a citizen of Kenya or Fiji, Haiti or Ivory Coast, your chances of getting treatment for diabetes were low, and your risk of living a life severely affected by diabetes was high.

Until recently, diabetes was not considered an important public health concern by any international development organization, bank, or national government, and often not even by medical experts. Most support for healthcare in poorer countries focused on malaria, AIDS and tuberculosis, or acute outbreaks of disease.

Dramatic change

In recent years, the disease situation has changed dramatically in developing countries. Today it is known that out of 400 million people with diabetes worldwide, over 300 million live in developing countries. By 2035, or even before, these numbers will have gone up by at least another 100 million if the necessary action is not taken.

Why is this important?

The fact is that diabetes is a big problem to a poor person and his/her family: diabetes is a chronic disease that requires long-term care and medication. If care is not available, diabetes and its complications (such as stroke, high blood pressure, blindness, foot amputation, kidney failure), will affect the ability to work and to sustain a household and family. Even if care is available, it is often too costly for the poor. Diabetes in a family and a household leads to poverty, and this will also then affect the next generation.

Multiplying these scenarios by 300 million or more, the magnitude of the consequence for people with diabetes, their families, their communities, and to businesses, economic growth and development, is unbearable.

Necessary action

But, what then is ‘necessary action’? Do we know what to do to stop diabetes in poor countries?

The World Health Organization (WHO) has published a guideline called Tackling NCDs – best buys and other recommended interventions with clear, simple, and cost-efficient suggestions, focusing on developing countries. Some of the most important of these are:

  • Reduce sugar consumption from sugar-sweetened drinks, especially among children and youth, through healthy diet information campaigns and higher taxation, in order to prevent obesity which is the main cause of diabetes.

Also vital is to train healthcare providers at local level health clinics to:

  • Administer basic diabetes care, in order to improve blood sugar control for people with diabetes.
  • Support people with diabetes to do better blood sugar monitoring at home, and carry out home visits to sustain this.
  • Provide foot care for people with diabetes, to avoid amputations.
  • Offer eye screening to people with diabetes, at least once per year, to avoid blindness.
  • Provide care and education to pregnant women or women of child-bearing age who have diabetes in order to ensure blood-sugar control during pregnancy, and so to avoid complications for the mother and child at birth and afterwards.
Have you read?

The big problem today is that while best buys and other solutions to diabetes care and prevention are known - and even implemented with success on the ground in many developing countries, see examples here – the funding available is far from enough.

Developing and developed countries commit to spending only a small amount of what is needed. This has to change if the burden from diabetes is to be stopped from slowing economic growth and keeping people stuck in poverty.

Much more focus on the prevention of diabetes, and on its early diagnosis, with efficient and low-cost care made available at local community level, are the solutions that everybody agrees on.

More resources

But many more resources are needed urgently, because today many developing countries are unable to move forward at larger scale with "best buys" and other solutions.

The World Diabetes Foundation (WDF) has for the past 15 years funded projects in more than 100 countries aiming to improve diabetes care and prevention, always seeking to reach the poorest populations. We work in partnership with ministries of health, civil society organizations, universities and the private sector within developing countries, and we seek international co-partners worldwide.

More than 500 projects have been funded so far and supported implementation of best buys and many other solutions that are now more widely available than ever before.

Our many partners worldwide have shown that best buys can indeed be implemented to offer diabetes care to the poorest, and raise awareness and spread knowledge about prevention of diabetes. Commitments are called for at all levels to scale up and make efficient diabetes care and prevention programmes the rule rather than the exception in the developing world.

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