Diabetes: The forgotten killer
Paul ZimmetChina Daily  Updated: 2005-10-26 05:47

You could be forgiven for thinking communicable illnesses, like HIV/AIDS, and the newly feared bird flu, are the major disease threats facing Asia.

After all, an APEC meeting has been called to focus on bird flu, scientists are fretting over a bird flu vaccine, and Asian bird flu casualties are being cited as early signs of a potential pandemic.

Every year we wince as we hear the forecast HIV/AIDS death toll in Asia being revised upwards, as the disease continues its relentless march of devastation.

It would be foolish to in any way discount the potential impact of these diseases. But a much greater health concern looms on the horizon that risks being overlooked.

Diabetes is far more certain than bird flu to prematurely claim millions of lives. Similarly, diabetes-related deaths in Asia over the next few decades will dwarf those caused by HIV/AIDS.

Sounds far-fetched? Not according to the World Health Organization, which has just released a report claiming chronic diseases, dominated by diabetes, now cause twice as many deaths as infectious diseases - including HIV - maternal and perinatal conditions, and nutritional deficiencies combined.

The report, "Preventing Chronic Diseases: A Vital Investment" claims this trend will continue.

In the next decade, the number of lives claimed by diabetes around the world is set to grow by a quarter, driven by rising obesity and inactivity. It could cause the first life expectancy reduction in more than 200 years. Nowhere is the problem more serious than in Asia.

There are 90 million people with diabetes in Asia. The continent is home to four of the world's five largest diabetic populations - India, 33 million people with diabetes; China, 23 million; Pakistan, 9 million; and Japan, 7 million.

The WHO estimates the global diabetes population will grow to more than 200 million by 2010 and 330 million by 2025. The burden in Asia will increase - in less than a decade, 60 per cent of all diabetes sufferers will be in Asia.

Asia should be in a state of panic.

While diabetes can be treated, with limited access to medicine the majority of people affected will die prematurely.

Even with treatment diabetes shortens lives, as well as robbing sufferers of happiness when they are alive and putting a significant strain on resources.

There is a common misconception that diabetes is not lethal, with deaths often attributed to complications rather than the disease itself. But diabetes puts people at risk of many other diseases and premature death as it causes damage to many body tissues, and progresses to strokes, heart disease, kidney failure, blindness, susceptibility to serious infections and amputations due to loss of circulation.

Diabetes has crept up on Asia with progressive Westernization or "Coca-Colanization" of its countries, with the adoption of fatty food diets and sedentary lifestyles. Disturbingly the non-insulin dependant variety of diabetes (type 2), with typical onset in late adulthood in most parts of the world, is surfacing among children in Asia.

With scarce health resources, Asia is ill-prepared to tackle diabetes effectively and is likely to be distracted by more immediate threats such as bird flu, which it is being asked by countries outside the region to address.

There is also a lack of recognition of the crisis, with many governments and public health planners in Asia remaining largely unaware of the future potential consequences of obesity, and diabetes and its serious complications.

Unless this situation is rectified, there will be a huge economic burden on Asia - both from direct healthcare costs and indirect costs from a decline in workplace productivity. In addition there will be losses due to premature morbidity and mortality.

Diabetes could cripple the budgets of Asian nations, particularly in developing nations. Diabetes is expected to cost the larger Asian economies up to US$500 billion each in the next decade due to lost productivity and premature deaths.

At the Sixth International Diabetes Federation conference for Asia in Bangkok this week, I will predict that when the history of this century is written, it will be diabetes, not bird flu or HIV/AIDS, that will have had the most devastating impact on the Asia Pacific.

There is no doubt that if bird flu is serious enough to warrant an APEC meeting later this year, a similar meeting on diabetes is long overdue.

Diabetes has to be addressed in a significant way in Asia. It does not have the high profile of bird flu or HIV/AIDS, but it is a killer disease we are not prepared for, with the potential to claim millions of lives.

The author is director of the International Diabetes Institute and head of the World Health Organization Collaborating Centre for the Epidemiology of Diabetes

(China Daily 10/26/2005 page4)

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