Diabetes is the new health monster

Diabetes is a new pandemic, a disease spreading across continents through the developed and developing world. It’s not even a virus. Whether it hits children, old people or the rich, it is an expensive and debilitating disease that demands continuous treatment until death. The drugs are available but, as is often the case, they are not always available where they are most needed. More important, diabetes is a disease that can be prevented.

Let’s start with children. India has trouble feeding its 1.2 billion population and yet obesity and diabetes in children has become a problem for middle class families. Some 23% of urban 5-14 year olds are overweight and 11% are obese. India has the highest number of diabetics in the world – 51 million of them. This is partly because they adopted the same affluent lifestyles as in the West and partly because South Asian people seem genetically more susceptible to it.

Unfortunately for Chinese children, a recent US study found diets rich in vegetables and fruit still led to obesity. Researchers put this down to heavy use of deep frying and stir-fries, as well as increased consumption of Western food. About 20% of Chinese children and a third of boys are overweight, compared to less than 2% in 1985. This is a frightening increase, compared to the rate in America.

According to the American Diabetes Association (ADA), a quarter of US adults have diabetes. In a 199-country analysis, the number of adults with diabetes has doubled in the past 30 years to 347 million in 2008. This is attributed to population growth and aging, as well as unhealthy diet and sedentary lifestyle. Obesity is a risk factor for type 2 diabetes and obesity among children is increasing: more than 20% of American children 2-5 years old are overweight or obese. However, 80% of worldwide diabetics are expected to be living in low or middle income countries in 2030 so the problem is unfortunately not confined to the rich West.

In Africa, where malaria and HIV were the main killers, lifestyle diseases are taking over. The region is used to high starch diets and drought, so people take pride in gaining weight as proof of wealth. Moreover, Kenyans are suffering the “Coca-Colaisation” of their society and the government is considering banning advertising near schools. Africans, like South Asians, also have a strong gene for diabetes.

If 7.8% of the global population will be diabetics by 2030, it will be an enormous drain on our medical system. Moreover, the West overpays for insulin, because there are cheaper versions of it that are often ignored in favour of the expensive versions. Insulin turned 90 in 2011 but does not cure diabetes; it only staves it off. Some $US418 billion was spent on insulin in 2010, which went to a small group of beneficiaries including Novo Nordisk, Eli Lilly and Sanofi-aventis. It could help if health services starter to buy cheaper versions, which would allow smaller companies to produce cheap insulin in competition with the global giants.

With these startling statistics in mind, it will be critical for governments to pay more attention to the supply and cost of insulin, and emphasise the prevention of obesity and diabetes. This could be an uphill battle, given the attractiveness of this massive lifelong market to Big Pharma.

(NB: McDonald’s has just reduced the number of fries in a Happy Meal and added apple slices, carrots, raisins, mandarin and pineapple slices to the meal. This reduces its calorie count by 20%.)

Ref: South China Morning Post (China), 19 April 2011, Childhood obesity, diabetes plague India. www.scmp.com
The Lancet (UK), 9 July 2011, The diabetes pandemic. Editorial. www.thelancet.com
The Financial Times (UK), 17-18 September 2011, Africa struggles to control prolific killer. K Manson. www.ft.com
Slate.com (US), 26 July 2011, McDonald’s revamps Happy Meal to include fruit. C Gossmann. www.slate.com
The Atlantic (US), 20 July 2011, Are vegetables and exercise causing childhood obesity in China? www.theatlantic.com
Prospect (UK) November 2011, Health emergency in slow motion. J Elwes. www.prospectmagazine.co.uk
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Search words: diabetes, China, India, America, Africa, drugs, insulin, children, obesity, McDonald’s, lifestyle, sugar, Novo Nordisk, Eli Lilly, Sanofi-aventis.

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