Diabetes Around the Globe

DIABETES

Global health issue exploration

As obesity becomes an increasingly serious problem worldwide, diabetes has likewise become equally problematic, given that the two conditions are interrelated. "Fueled by rapid urbanization, nutrition transition, and increasingly sedentary lifestyles, the epidemic has grown in parallel with the worldwide rise in obesity" (Hu 2011). Unless the chronic disease of type II diabetes can be better managed and contained, there are potentially severe and long-lasting consequences for the world as a whole. It is of particular concern that diabetes is becoming a health issue in the developing world, an area where under-nutrition (versus over-nutrition) was once considered to be of greater concern. The purpose of this paper will be to give an overview of the condition and its consequences for sufferers and for healthcare providers on a global level, as well as suggest possible sources of treatment

Diabetes is no longer a disease of affluence. According to the International Diabetes Federation the problem of diabetes "affects at least 285 million people worldwide, and that number is expected to reach 438 million by the year 2030, with two-thirds of all diabetes cases occurring in low- to middle-income countries. The number of adults with impaired glucose tolerance will rise from 344 million in 2010 to an estimated 472 million by 2030" (Hu 2011). In fact, diabetes is increasingly a disease of the poor, who have impeded access to healthy foods and places to exercise and who must rely upon processed, convenience foods as sources of sustenance. The Westernization of the developing world has also disrupted indigenous ways of life, with a particularly serious impact upon persons with specific genetic profiles. Although diabetes is a crisis nearly everywhere, it does not impact all populations to the same degree or in perfect correlation with the rise in obesity.

Diabetes: The New Epidemic in Asia

On example of how previous assumptions of what constitutes traditionally-accepted high-risk populations that have diabetes is changing is the explosion of diabetes in Asia and India. These countries have proven to be particularly vulnerable because of the rapid explosion of the middle class and the increased prevalence of sedentary middle-class lifestyles. Also, there are indications that certain genetic factors may make Asian populations more vulnerable to diabetes. "Asians develop diabetes at younger ages, at lower degrees of obesity, and at much higher rates given the same amount of weight gain" as Caucasians (Hu 2011).

At the present time, "Asia accounts for 60% of the world's diabetic population," an extraordinary development in a region where famine was considered of higher risk (Hu 2011). "In 1980, less than 1% of Chinese adults had the disease. By 2008, the prevalence had reached nearly 10%" while "in urban areas of south India, the prevalence of diabetes has reached nearly 20%" (Hu 2011). Excessive caloric intake is considered the primary culprit of the proliferation of diabetes. However, certain specific types of foods and beverages have been identified as particular culprits in insulin-resistance (the primary metabolic hallmark of type II diabetes).

For example, sugar-sweetened soda consumption has been associated with an increase in metabolic syndrome and diabetes, as has fast food consumption (given that fast foods contain higher amounts of non-satiating yet highly palatable sugar and salt). "In China alone, the number of McDonald's outlets grew from 1 in 1990 to 1,000 in 2006, and the company has plans to double this figure by 2013. Meanwhile, daily per capita sales of carbonated soft drinks in China increased 145% and 127% for Coca Cola and PepsiCo, respectively, between 2000 and 2010" (Pan, Malik, & Hu 2012). These are not merely correlates with obesity: there is also evidence of a causal effect, given the impact such foods have upon glucose tolerance levels.

Lessons from the Asian example: Quality vs. quantity in calories

Even in nations without specific genetic vulnerabilities, however, much can be learned from the example of Asia and the rising obesity epidemic. There is an increased rate of deaths due to chronic, lifestyle-related diseases worldwide. According to the World Health Organization (WHO), of 57 million deaths worldwide in 2008; 36 million (63%) were due to non-communicable diseases like diabetes (Global status report on NCDs, 2010). This indicates a need to shift the paradigm of disease prevention. While once the focus was upon preventing diseases associated with epidemics such as tuberculosis, although communicable diseases are still a concern, there are greater numbers of persons dying from conditions associated with diabetes worldwide. "NCDs are the most frequent causes of death in most countries in the Americas, the Eastern Mediterranean, Europe, South-East Asia, and the Western Pacific (Global status report on NCDs, 2010).

A shift in thinking is demanded from merely getting 'more calories' to food insecure populations and getting the right type of calories delivered in an affordable fashion. A national example of this can be seen in the U.S. school lunch program, where the number of calories allotted per student has been reduced with a corresponding effort to improve the quality of nutrition for every student. The 2010 The Healthy, Hunger-Free Kids Act (passed in 2010) increased the mandatory servings of fruits and vegetables for schools in subsidized lunches; increased the number of whole grains vs. simple sugars and carbs; and also replaced whole milk with low-fat and skim milk. The number of calories allotted per lunch was reduced as was the allowed amounts of saturated fat and sodium (School meal nutrition standards, 2010). Given that lower-income children are disproportionately affected by diabetes and obesity and are also disproportionately reliant upon school lunches, it is hoped that this will have a positive overall impact upon diabetes rates in high-risk populations.

Conclusion