Economic burden of diabetes

Diabetes is one of the major health and development challenges of the 21st century. There are currently 371 million people living with diabetes and another 280 million are at high risk of developing the disease across the world. Half a billion people are expected to be living with diabetes by 2030.
Diabetes and its complications are largely preventable and there are proven, affordable interventions available. Everyone is concerned and has a role to play in helping turn the tide of diabetes to protect our future.
Diabetes is difficult to handle. It imposes life-long demands on people with diabetes, requiring them to make multiple decisions related to managing their conditions. People with diabetes need to monitor their blood glucose, take medication, exercise regularly and adjust their eating habits.
Diabetes is a chronic disease that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Insulin is a hormone made by the pancreas that enables cells to take in glucose from the blood and use it for energy. Failure of insulin production, insulin action or both leads to raised glucose levels in the blood (hyperglycaemia). This is associated with long-term damage to the body and the failure of various organs and tissues.
There are two main types of diabetes: Type 1 diabetes is an autoimmune disease characterised by destruction of the insulin-producing cells in the pancreas. Consequently, people with type 1 diabetes produce very little or no insulin and must take insulin to survive. Type 1 diabetes, which used to be called juvenile-onset diabetes, is most commonly diagnosed in children and young adults. Type 2 diabetes is marked by insulin resistance. People with Type 2 diabetes cannot use the insulin that they produce effectively. They can often manage their condition through exercise and diet. However, in many cases oral drugs are needed and often insulin is required.
Type 2 diabetes accounts for over 90 per cent of the more than 300 million people living with diabetes worldwide. Both Type 1 and Type 2 diabetes are serious. A third type of diabetes is gestational diabetes (GDM), a condition in which women without previously diagnosed diabetes have high blood glucose levels during their pregnancy.
GDM affects about 4 per cent of all pregnant women. It has few symptoms and usually disappears when the pregnancy ends. Women who had GDM have a significantly increased risk of developing Type 2 diabetes.
Introduced in 1991 by the International Diabetes Federation and the World Health Organisation in response to growing concerns about escalating health threat that diabetes poses as an epidemic, the World Diabetes Day (WDD) is observed every year on November 14. The day engages millions of people worldwide in diabetes advocacy and awareness.
The World Diabetes Day became an official United Nations Day in 2007 with the passage of the UN Resolution 61/225 proposed by Bangladesh. The Bangladesh Diabetic Samity (BADAS) backed the government and became instrumental in campaigning for this resolution to draw attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight. The WDD logo was also adopted in 2007 to mark the passage of the UN World Diabetes Day Resolution. The logo is the blue circle - the global symbol for diabetes which was developed as part of the 'Unite for Diabetes' awareness campaign.
The significance of the blue circle symbol is overwhelmingly positive, portraying the unity of the global diabetes community in response to the diabetes pandemic. Across cultures, the circle symbolises life and health. The colour blue reflects the sky that unites all nations and is the colour of the UN flag.  
According to the latest data released by the International Diabetes Federation (IDF),
* Almost 400 million people have diabetes. By 2035, this will rise to 592 million,
*  The number of people with Type 2 diabetes is increasing in every country,
* About 80 per cent of people with diabetes live in low-and middle-income countries,
* The greatest number of people with diabetes ranges between 40 and 59 years of age,
* About 78,000 children develop Type 1 diabetes every year,
* About 175 million people (50 per cent) with diabetes are undiagnosed
* Diabetes caused 5.1 million deaths in 2013. A person dies every six seconds,
* Diabetes caused at least US$548 billion dollars in healthcare expenditures in 2013; 11 per cent of total healthcare expenditures in adults (20-79 years) diabetes now affects over 360 million people worldwide. If nothing is done to reverse the epidemic, IDF predicts that by 2030, more than 500 million people will live with diabetes.
The economic consequences of diabetes include three-cost types:
* Social welfare costs-the value that people place on better health,
* Macro-economic costs-the GDP losses of the countries incur due to ill health in the population, and
* Microeconomic costs-household financing of care, changes in consumption patterns, and foregone earnings of individuals and households due to the ill health among members.
A recent study in India suggested that an annual welfare gain equal to about three times that country's GDP in 2000. Such high numbers reflect substantial value that people attribute to reduced mortality and better health, a value that  exceeds any narrower economic cost measure.
Healthcare expenditures spent on diabetes account for 11.6 per cent of the total healthcare expenditure in the world in 2010 .This percentage varied from 7 per cent in the Africa region to 14 per cent in the Middle East and North African Region and North America and Caribbean region. About 95 per cent of the countries will spend 5 per cent or more, and about 80 per cent of the countries will spend between 5 per cent and 13 per cent of their total healthcare dollars on diabetes.
The figures indicate that health expenditures for diabetes will grow by 30 per cent to 34 per cent between 2015 and 2030, which is more than the assumed global population growth (28.6 per cent) among persons aged 20-79 years over the same period. Expenditures will grow more quickly than population because the global prevalence of diabetes will increase as a result of ageing.
The writer is Chairman of the Chittagong Stock Exchange and Chief Coordinator, Diabetic Association of Bangladesh. [email protected]