The global dominance of diabetes: more than quadrupled in China in past 18 years
The Diabetes Atlas, published by the International Federation of Diabetes on Nov 14, World Diabetes Day, shows the seemingly relentless spread of diabetes that now affects an estimated 382 million people worldwide, a number likely to approach 600 million by 2035. 80% of those affected are in developing countries, and worryingly, the age of onset is falling.
The consequences of 8·3% of the world’s population having some form of diabetes are widespread. They affect socioeconomic development, complicate clinical care with comorbidity, increase health-care costs, and limit life expectancy—both for those affected and their children. The prevalence of type 2 diabetes, which makes up most of the disease burden, is exacerbated by ageing populations and increases in weight. Furthermore, the popularity of Western behaviours encourages an obesogenic environment that can make healthier choices about food and exercise less accessible, despite the fact that such choices can prevent and control type 2 diabetes more effectively than can medication.
In China, the number of people with diabetes has climbed from 2% in 1995 to 9·6% in 2013—almost 100 million people. It is to China’s credit, in foreseeing the challenge of non-communicable diseases, the country is working towards universal health coverage. By contrast, the absence of a universal system that enables access to care in India, where the number of people who have diabetes is set to grow from 65 million in 2013 to 109 million in 2035, will inevitably lead to productive lives cut short by diabetic complications.
Unchecked, diabetes threatens to overwhelm societies and health-care systems. Yet, the rise of diabetes is not inevitable. Societies and individuals have choices about lifestyle, food production, famine relief, urbanisation, and the built environment. Through their daily exposure to people with diabetes, its risk factors, and complications, health professionals are ideally placed to advocate for healthier choices that can reduce the prevalence and consequences of diabetes. How well they do this will be reflected in future editions of the Atlas.