Economic impact of diabetes

National Professor Dr Muhammed Ibrahim, a brilliant physician, a gifted teacher, a talented organiser and a great reformer was born on
December 31, 1911 and died on  September 06, 1989. His death anniversary is observed as (Diabetic) Service Day (Sheba Dibash) as a mark of respect for his great contribution to socio-medicare services.
Diabetes is a chronic condition that occurs when the body cannot produce enough or effectively use insulin. Insulin is a hormone produced by pancreas that allows glucose from food to enter the body's cells where it is converted into energy for muscles and tissues to function. As a result, a person with diabetes does not absorb glucose properly, and glucose stays circulating in the blood (hyperglycaemia) damaging the tissues over time.  This damage leads to life-threatening complications.
According to Sixth Edition of Diabetes Altlas (2014) published by the International Diabetic Federation, the estimated number of adults living with diabetes has soared to 374 million, representing 8.4 per cent of the global adult population. This number is projected to rise to 552 million people by 2030, or 9.9 per cent of adults, which means approximately three more persons every 10 seconds. There is no denying of the fact that diabetes thrusts a large economic burden on any national health care system. Estimated figures show healthcare expenditures on diabetes accounted for 11.6 per cent of the total healthcare expenditure in the world in 2010. About 95 per cent of the countries of the world spend 5.0 per cent or more of their total healthcare budget on diabetes. IDF estimates also project that global health expenditures to prevent and treat diabetes and its complications surpassed US$376 billion in 2010 and will exceed US$490 billion by 2030. An average of US$703 per head was spent on diabetes in 2010 globally. More than three-quarters of the global expenditure in 2014 were used for persons between 50 and 80 years of age. Also, more money is expected to be spent on diabetic care for women than men.
Research results show that there is a large disparity in healthcare spending on diabetes between regions and countries. More than 80 per cent of the global expenditures on diabetes are made in the world's economically richest countries, not in the low or middle-income countries where 80 per cent of people with diabetes live. Recent studies drew three major conclusions on overall economic impact of diabetes
First, diabetes imposes a large financial burden on people with diabetes and their families. The size of this burden depends on their economic status and the social insurance policies of the countries in which they live. Individuals with diabetes and their families in developing countries pay a larger share of the expenditure because of the poorly organised systems of medicare insurance and/or lack of governmental provisions of medical services. In the poorest countries, people with diabetes and their families bear almost the whole cost for whatever medical care they can afford. In Bangladesh, clinical cum social services (a certain percentage of free services) are offered to diabetic patients through chain hospitals and healthcare centres of Diabetic Association. In India, the poorest persons with diabetes spend an average of 25 per cent of their total income on healthcare.
Secondly, at the societal level, diabetes leads to loss of productivity and economic growth. The American Diabetes Association estimated that the US economy lost US$58 billion, equivalent to about a half of the direct health care expenses on diabetes in 2007, as a result of lost earnings due to lost working days, restricted activity days, lower productivity at work, mortality and permanent disability caused by diabetes. Such losses are found  relatively higher in poorer countries as premature death due to diabetes occurs at much younger age. The World Health Organisation (WHO) forecast net losses in national income from diabetes and cardiovascular diseases of ID557.7 billion in China, ID303.2 billion in the Russian Federation, ID336.6 billion in India, ID49.2 billion in Brazil and ID2.5 billion in Tanzania (2005 ID) between 2005 and 2015.
Finally, the largest economic burden caused by diabetes in terms of monetary value is associated with disability and loss of life as a result of the disease itself and its related complications, including heart, kidney, eye and foot diseases. Economists have used different methods to valuate disability and loss of life associated with diseases and the most appropriate method is still under debate. No matter what method is used, it is very likely that the economic burden that is measured by the monetary value associated with this disability and loss of life would be far larger than the estimated economic burden using measures described above.
Most people with diabetes live in the economically less developed regions of the world. Even in the region with the lowest prevalence (Africa) it is estimated that around 280,000 deaths were attributable to diabetes in 2011. While more than 80 per cent of people with diabetes live in low and middle income countries and only 20 per cent of global healthcare expenditures on diabetes were spent in these countries, reflecting huge disparities.
 Diabetes is reaching epidemic proportions worldwide. Every year more people are diagnosed with diabetes, yet there are still many (more than 50 per cent) people who have diabetes but they are unaware of it. In a survey report it is indicated that the prevalence of diabetes in Bangladesh in population aged over 15 years is between 2-5 per cent. This type of similarity is also found in most of the under-developed countries.  
Diabetes is a life-long and non-episodic disease. It affects many other organs of the body. So a comprehensive and good pathological support-based treatment is needed to manage it. Self-management of the patient is also an important factor for diabetes management. At the same time, record keeping and health education of the patient and his/her community are also needed.  
The writer is a former Secretary and Chairman, NBR, and
Chief Coordinator, Diabetic Association of Bangladesh.
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