The Unseen Ongoing Pandemic: Diabetes.
In December 2021, the International Diabetes Federation (IDF) published the 10th edition of their Diabetes Atlas. The report consists of 219 data sources from 144 countries to estimate diabetes prevalence. The Atlas stated that diabetes ranks among the top 10 causes of mortality globally. Currently, 537 million adults (20-79 years) worldwide have diabetes – 1 in 10 – representing 10.5% of the world’s population in this age group. Alarmingly, diabetes is expected to rise to 643 million by 2030 and 783 million by 2045. Worldwide, diabetes was responsible for 6.7 million deaths in 2021 – 1 every 5 seconds. More than 75% of adults with diabetes live in low- and middle-income countries.
Diabetes caused at least 966 billion dollars in health expenditure, representing a 316% increase over the last 15 years. Around 541 million adults have impaired glucose tolerance, which places them at high risk of type 2 diabetes.
In the African (AFR) region, 1 in 22 adults – 24 million – live with diabetes. 1 in 2 – 54% – people living with diabetes are undiagnosed, which represents the highest of all regions. 1 in 8 live births are affected by hyperglycaemia in pregnancy. Diabetes was responsible for 416,000 deaths in 2021. Despite the lowest diabetes prevalence estimate of 4.5% among the IDF countries, the estimated increase in the number of people with diabetes living in the AFR Region by 2045 is the highest at 129%, reaching 55 million. It is likewise predicted to have the highest increase of 107% in people with impaired glucose tolerance by 2045, reaching 117 million.
Diabetes imposes a substantial economic burden on people suffering with the disease, their families, health systems, and countries in general. An estimated 240 million people live with undiagnosed diabetes worldwide, meaning almost one-in-two adults with diabetes are unaware they have the condition. Globally, 87.5% of all undiagnosed cases of diabetes are in low and middle-income countries, with low-income countries having the highest proportion undiagnosed. Still, a serious concern is that people with diabetes diagnosed later are likely to use more healthcare services due to the greater likelihood of diabetes complications, placing an added burden on healthcare systems already under pressure. The low clinical diagnosis rate for diabetes is often due to poor access to health care and limited institutional capacity and infrastructure from the health systems. In Africa, South-East Asia, and the Western Pacific, more than half of people with diabetes are undiagnosed. However, even in high-income countries, almost a third – 28.8% – of people with diabetes have not been diagnosed.
For years, diabetes has been mainly treated with generic drugs and conventional insulins. More than 50 new diabetes medications hit the market in the past two decades, comprising new formulations of insulin and other injections and pills. Some of the medications people with diabetes must take to lower their high blood glucose risk go too far, tipping a patient into hypoglycemic crisis. Ratcheting up doses would increase that danger, especially for older people, already at greater risk due to their age and condition. Recently, the pharmaceutical industries have been targeting people diagnosed with prediabetes. Prediabetes is a term used to describe when someone becomes insulin resistant. Although it seemed like this would have a positive effect in preventing diabetes, what is happening is the opposite. The push to diagnose and treat prediabetes has come at a cost. When told they have the condition, many people face psychological and financial burdens trying to address it. No drugs have been explicitly approved for prediabetes, meaning that doctors are limited to prescribing diabetes drugs or other medications to treat the condition. But drug companies are testing dozens of medications aimed at prediabetes in hopes of tapping a potential worldwide market of hundreds of millions of people.
The reality is that as the prediabetes definition has broadened, the number of potential patients worldwide has dramatically increased. Indeed, not only the pharmaceutical industry is trying to benefit from medicalizing prediabetic people. Some companies already have sought a seal of approval on foods or supplements—such as coffee, dairy products, and sugar substitutes—that they say can help prevent diabetes. This option contributes to over-medicating people who shouldn’t be on chronic medication and gives the pharmaceutical industry more control over people’s health and finances.
Many public health organizations believe a mainly clinical approach to diabetes prevention is ineffective. The World Health Organization, for example, favors society-wide solutions, which aim to address the health impacts of social stratification and failures of urban planning. It endorses laws that help reduce the consumption of sugary drinks and unhealthy foods. Undoubtedly, there is a considerable need to identify diabetes sooner, but it should not come at people’s cost and health. Inexpensive screening strategies using validated diabetes risk scores, combined with diagnostic tests, should be used to identify people with diabetes earlier and expand coverage of preventive counselling, diagnosis, and clinical care.
During the first wave of COVID-19, people with diabetes had a 3.6-fold higher likelihood of hospitalization due to COVID-19 than those without diabetes. COVID-19 infections and deaths per 100,000 are higher in countries that have a high prevalence of diabetes. Since the pandemic began, the global healthcare community has accumulated invaluable clinical experience in providing diabetes care in the setting of COVID-19. The current clinical management of diabetes is a work in progress. It requires a shift in patient-provider interaction beyond the walls of clinics and hospitals: the use of telemedicine when feasible, innovative patient education programs, strategies to ensure medication and glucose testing availability and affordability, as well as numerous ideas on how to improve meal plans and physical activity.
The COVID-19 and diabetes pandemics have imposed an unprecedented challenge on the lives of millions of people around the world. Improving diabetes control in the outpatient setting at this time in history is crucial to reduce the risk of severe COVID-19 should one acquire it. The comprehensive management of dysglycemia and commonly present derangements such as hypertension, dyslipidemia, cardiovascular and renal disease can significantly reduce morbidity mortality rates. Governments and health organizations must raise awareness and address all social determinants of health that increase the risk of diabetes, COVID-19 and other health threats. Particular attention should be placed on the grossly evident disparities in the rates of diabetes and now COVID-19 in racial/ethnic minorities compared to mainstream white populations.
How do we help as organizations?
The Noakes Foundation
The Noakes Foundation is a Non-Profit Corporation founded for public benefit which aims to advance medical science’s understanding of the benefits of a low-carb high-fat (LCHF) diet by providing evidence-based information on optimum nutrition that is free from commercial agenda.
The Noakes Foundation acts as a catalyst of change and through the sound research and practices of the foundation seeks to reveal what genuine healthy nutrition looks like and, in doing so, make a difference in the lives of millions of people. We endeavor to offer top quality research with regards to the LCHF lifestyle and the health benefits associated with its adoption.
The Nutrition Network is an education, connection and learning platform founded by The Noakes Foundation in partnership with an esteemed team of doctors and scientists. The platform has been designed for healthcare practitioners across all disciplines, covering the latest science and research in the field of Low Carb Nutrition.
The purpose of the Nutrition Network is to actively share the knowledge, research, analysis, and practical skills that already exist in the area of LCHF (Low Carb High Fat) with those wanting to learn more and implement these strategies into their clinical or professional practice.
Nutrition Network contributes by donating a portion of each Nutrition Network course enrolment fee towards funding Eat Better South Africa and the important work they are doing in South African communities.
Eat Better South Africa
Eat Better South Africa! (EBSA) is the community outreach branch of The Noakes Foundation, and is an intervention programme aimed at educating people from lower income areas, teaching them to get better by eating better.
EBSA’s mission is to educate under-resourced community members about the dangers of excessive sugar and carbohydrate consumption, and to teach them how to make better food choices through dietary education, meal and budget planning, and general nutritional awareness.
Eat Better South Africa is implementing programmes across South Africa through their network of community coaches and aims to encourage and contribute to the improvement of dietary healthy in the country.
Caballero, A.E.; Ceriello, A.; Misra, A.; Aschner, P.; McDonnell, M.E.; et al. COVID-19 in people living with diabetes: An international consensus. Journal of Diabetes and Its Complications. 2020;34(9): 107671. https://doi.org/10.1016/j.jdiacomp.2020.107671
Charity, E.I. The pandemic and the pharmaceutical world. European Pharmaceutical Review. 2021. Available at: https://www.europeanpharmaceuticalreview.com/article/140389/the-pandemic-and-the-pharmaceutical-world/
Piller, C. The war on ‘prediabetes’ could be a boon for pharma—but is it good medicine? Science. 2019. Available at: https://www.science.org/content/article/war-prediabetes-could-be-boon-pharma-it-good-medicine
Respaut, R.; Terhune, C.; Nelson, D.J. Drugmakers pushed aggressive diabetes therapy. Patients paid the price. Reuters Investigates. 2021. Available at: https://www.reuters.com/investigates/special-report/usa-diabetes-overtreatment/
About the author
Georgina Pujol-Busquets Guillén
Georgina holds a BSc in Pharmacy from the University of Barcelona, Spain and an MSc in Nutrition and Public Health and an MSc in Global Health. After working in community pharmacies and public hospitals in Spain, USA, and Peru, she realized the need for a nutritional approach to chronic disease. She worked as an intern for The Noakes Foundation in 2017 and she has finalized her PhD in Physiology at the University of Cape Town. She is part of Eat Better South Africa’s research team and her study was a mixed-method project to evaluate the effectiveness of Eat Better South Africa nutrition education program on components of metabolic health and well-being in women from South African under-resourced communities.
She is also teaching Qualitative Methods at the Master of Nutrition and Public Health at the Open University of Catalonia. In 2021 she was the recipient of the Tim & Marilyn Noakes Grant fellowship and she will start a Postdoctoral position at MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) at the University of the Witwatersrand. Georgina is passionate about inequality, women’s rights, nutrition, public health, and diet-related diseases. Her research career is focused on understanding the social determinants that affect women’s health in low-income communities and how to bring low carbohydrate diets into those areas to treat metabolic diseases. She believes that through Eat Better South Africa programs women are empowered and consequently, the wider community is influenced by virtue of their position in their household.