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Diabetes in the Disadvantaged
is an IDF Theme

Diabetes threatens many of the world’s indigenous people.

REVIEWED BY PROFESSOR PIERRE LEFèBVRE
World Diabetes Day is celebrated every year on November 14, according to a news release from the International Diabetes Federation (IDF). The date commemorates the birthday of Frederick Banting, who, along with Charles Best, is credited with the discovery of insulin in 1921.

In almost every country of the world, diabetes is on the rise. The current number of people with diabetes stands at 246 million, according to the IDF’s new Diabetes Atlas. The disease is a leading cause of blindness, kidney failure, amputation, myocardial infarction and stroke. It is one of the most significant causes of death, responsible for 3.8 million deaths each year, similar to HIV/AIDS.

IDF President Professor Pierre Lefèbvre outlined the facts: “Over a 50-year period, diabetes has become a global problem of devastating human, social and economic impact. The total number of people living with diabetes is increasing by more than 7 million per year. If nothing is done, the global epidemic will affect over 380 million people within a generation. Unchecked, diabetes threatens to overwhelm healthcare services in many countries and undermine the gains of economic advancement in the developing world.”

Professor Lefèbvre is emeritus professor of medicine at the University of Liège, Belgium, where he has been chairman of the department of medicine (1988 to 2000) and head of the division of diabetes, nutrition and metabolic disorders (1970 to 2000).

DIABETES IN THE DISADVANTAGED AND VULNERABLE
The theme chosen by the IDF and the World Health Organization for the 2006 World Diabetes Day was diabetes in the disadvantaged and the vulnerable. Diabetes representative organizations worldwide are drawing attention to diabetes health inequalities and promoting the message that every person with diabetes has the right to the highest attainable health care that their country can provide.

Studies show that the economically disadvantaged are at higher risk of developing diabetes. The global picture reveals that within 20 years 80% of all people with diabetes will live in low- and middle-income countries, in many of which there is little or no access to life-saving and disability-preventing diabetes treatments. In affluent countries, people who are relatively poor are at greater risk of type 2 diabetes. In the United States, for example, households with the lowest incomes have the highest incidence of diabetes.

The impact of diabetes on these individuals and their families is often devastating. It is estimated that poor people with diabetes in some developing countries spend as much as 25% of their annual income on diabetes care. As IDF President-Elect Martin Silink puts it, “For some, the consequences of diabetes can be merciless. The economically disadvantaged are pushed further into poverty and face a terrible choice: pay for treatment and face catastrophic debt, or neglect their health and face disability or premature death.” Professor Silink is a pediatric endocrinologist at The Children’s Hospital in Sydney

The elderly, ethnic minorities and indigenous communities are all disproportionately affected by the diabetes epidemic. In developed countries, people aged >65 years are almost 10 times more likely to develop diabetes than people in the 20- to 40-year-old age group. In the United States, it is estimated that one in two people from ethnic minorities born in the year 2000 will develop diabetes during their lifetime, compared to one in three for the general population. In Canada, the prevalence of diabetes among First Nation peoples is three to five times higher than that of the general population in the same age group. The same is true among Australian Aborigines.

GATHERING OF EXPERTS IN MELBOURNE
In Melbourne at a gathering of diabetes experts from the United States, Canada, Australia and the Pacific Islands, researchers discussed findings that diabetes poses a deadly threat to the indigenous peoples across Asia, the Pacific and the Americas, as Western lifestyles and diets replace traditional habits. Professor Silink said indigenous people have a greater genetic risk of developing type 2 diabetes. “They also have genes that make the diabetes more damaging, so they are more prone to develop serious complications of diabetes,” he said in an interview with Reuters.

Conference host Professor Paul Zimmet said diabetes was unknown in the Pacific before World War II, but now the region has some of the highest rates in the world and the existence of indigenous communites at risk. Professor Zimmet is foundation director of the International Diabetes Institute, and professor of diabetes at Monash University, Melbourne at Deakin University, Victoria, Australia, and at the Graduate School of Public Health of the University of Pittsburgh. He is also cochair of the IDF Task Force on Epidemiology.

In the Pacific nation of Nauru, according to the Reuters report, the world’s smallest republic with a population of 10,000 people, >30% of adults aged>20 years have type 2 diabetes. Among adults aged ≥35 years, that number is one in two.

“It is a tragic situation, but not a lost one,” said Professor Zimmet. “The world needs to act now if we are to deal with this problem, which threatens to consume world economies and bankrupt health systems. It could also mean the end of some of our treasured indigenous groups.

TO DO NOTHING IS NOT AN OPTION
The diabetes epidemic threatens to be one of the greatest health catastrophes the world has ever seen. To coincide with November 14th this year, the IDF called on the global diabetes community to rally behind the campaign for a United Nations Resolution on diabetes by signing an online petition at www.unite
fordiabetes.org and passing a virtual version of the blue circle that has come to symbolize diabetes.

The IDF is pushing for a United Nations resolution to make governments to encourage more active lifestyles and better diets.

Professor Pierre Lefèbvre is the current President of the International Diabetes Federation. His office can be contacted by e-mailing Anne Pierson at anne@idf.org or Kerrita McClaughlyn at kerrita@idf.org.
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