Global burden

 “The availability of essential medicines and basic technologies is a critical component of Diabetes management.”

Even if the majority, 71% of countries have national Diabetes policies, national policies to address unhealthy diet and physical inactivity and national guidelines or standards for Diabetes management, globally an estimated 422 million adults were living with Diabetes in 2014, compared to 108 million in 1980.

The global prevalence (age-standardized) of Diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population. Over the past decade, Diabetes prevalence has risen faster in low- and middle-income countries than in high-income countries.

Diabetes caused 1.5 million deaths in 2012. Higher-than-optimal blood glucose caused an additional 2.2 million deaths, by increasing the risks of cardiovascular and other diseases.

The majority of people with Diabetes are affected by Type 2 Diabetes. This used to occur nearly entirely among adults, but now occurs in children too.

Diabetes and its complications bring about substantial economic loss to people with Diabetes and their families, and to health systems and national economies through direct medical costs and loss of work and wages. While the major cost drivers are hospital and outpatient care, a contributing factor is the rise in cost for analogue insulins, which are increasingly prescribed despite little evidence that they provide significant advantages over cheaper human insulins.

In general, primary health-care practitioners in low-income countries do not have access to the basic technologies needed to help people with Diabetes properly manage their disease. Which could be also considered against the will of Sir Frederick Banting, the founder of insulin, who made the patent available without charge and did not attempt to control commercial production.

Not treating well people with Diabetes also limiting them to contribute to the society in their full capability.

One study estimates that losses in Gross Domestic Product (GDP) worldwide from 2011 to 2030, including both the direct and indirect costs of Diabetes, will total US$ 1.7 trillion, comprising US$ 900 billion for high-income countries and US$ 800 billion for low- and middle-income countries.

Therefore we can clearly state that Diabetes imposes a large economic burden on the global health-care system and the wider global economy. This burden can be measured through direct medical costs, indirect costs associated with productivity loss, premature mortality and the negative impact of Diabetes on nations’ Gross Domestic Product (GDP).

Based on cost estimates from a recent systematic review, it has been estimated that the direct annual cost of Diabetes to the world is more than US$ 827 billion.

The International Diabetes Federation (IDF) estimates that total global health-care spending on Diabetes more than tripled over the period 2003 to 2013 – the result of increases in the number of people with Diabetes and increases in per capita Diabetes spending.

Direct medical costs associated with Diabetes include expenditures for preventing and treating Diabetes and its complications. These include outpatient and emergency care, inpatient hospital care, medications and medical supplies such as injection devices and self-monitoring consumables, and long-term care.

Besides the economic burden on the health-care system and national economy, Diabetes can impose a large economic burden on people with Diabetes and their families in terms of higher out-of-pocket health-care payments and loss of family income associated with disability and premature loss of life.

Sugar-Sweetened-Beverage Tax in Mexico

The prevalence of overweight and obesity in Mexico stands at more than 33% in children and around 70% in adults. Mexico has the highest prevalence of Diabetes among Organization for Economic Cooperation and Development (OECD) member countries, and the highest per capita consumption of soft drinks worldwide.

In January 2014 Mexico implemented a nationwide tax on drinks containing added sugar (bebidas azucaradas) that increased their price by over 10%. While it is too early to draw far-reaching conclusions, one analysis estimated that the 10% increase in the price of added-sugar drinks was associated with an 11.6% decrease in the quantity consumed.

During the first year of the tax, purchases of taxed sugar-sweetened beverages decreased by an average of 6% compared to what would have been expected without implementation of the tax, with higher reductions found in households of low socioeconomic status.

The availability of essential medicines and basic technologies for early detection, diagnosis and monitoring of Diabetes in primary health-care facilities is a critical component of Diabetes management capacity.

Diabetes is recognized as an important cause of premature death and disability. It is one of four priority noncommunicable diseases (NCDs) targeted by world leaders in the 2011 Political Declaration on the Prevention and Control of NCDs.

The declaration recognizes that the incidence and impacts of Diabetes and other NCDs can be largely prevented or reduced with an approach that incorporates evidence-based, affordable, cost-effective, population-wide and multisectoral interventions.

To catalyze national action, the World Health Assembly adopted a comprehensive global monitoring framework in 2013, comprised of nine voluntary global targets to reach by 2025.

Countries can take a series of actions, in line with the objectives of the World Health Organization NCD Global Action Plan 2013–2020, to reduce the impact of Diabetes:

  • Establish national mechanisms such as high-level multisectoral commissions to ensure political commitment, resource allocation, effective leadership and advocacy for an integrated NCD response, with specific attention to Diabetes.
  • Build the capacity of ministries of health to exercise a strategic leadership role, engaging stakeholders across sectors and society. Set national targets and indicators to foster accountability. Ensure that national policies and plans addressing Diabetes are fully costed and then funded and implemented.
  • Prioritize actions to prevent people becoming overweight and obese, beginning before birth and in early childhood. Implement policies and programmes to promote breastfeeding and the consumption of healthy foods and to discourage the consumption of unhealthy foods, such as sugary sodas. Create supportive built and social environments for physical activity. A combination of  social policies, legislation, changes to the environment and raising awareness of health risks works best for promoting healthier diets and physical activity at the necessary scale.
  • Strengthen the health system response to NCDs, including Diabetes, particularly at primary-care level. Implement guidelines and protocols to improve diagnosis and management of Diabetes in primary health care. Establish policies and programmes to ensure equitable access to essential technologies for diagnosis and management. Make essential medicines such as human insulin available and affordable to all who need them.
  • Address key gaps in the Diabetes knowledge base. Outcome evaluations of innovative programmes intended to change behaviour are a particular need.
  • Strengthen national capacity to collect, analyse and use representative data on the burden and trends of Diabetes and its key risk factors. Develop, maintain and strengthen a Diabetes registry if feasible and sustainable.

Everyone can play a role in reducing the impact of all forms of Diabetes. Governments, health-care providers, people with Diabetes, civil society, food producers and manufacturers and suppliers of medicines and technology are all stakeholders.

Management Sciences for Health (MSH) is a non-profit organization established in 1971. Since its establishment it has worked in over 150 countries to develop health systems, focusing on improving quality, availability and affordability of health services.

One of the tools developed by MSH is the International Drug Price Indicator Guide (IDPIG). The guide provides a variety of prices from different sources including pharmaceutical suppliers, international development agencies and governments.

This guide allows for comparison of prices of medicines of assured quality and is used as a reference in many approaches looking at access to medicines, for example the methodology developed by World Health Organization and Health Action International.

Using the online version of IDPIG, data from 1996 to 2014 were extracted from purchasers of insulin. All insulin formulations were standardized to an equivalent of a 10 ml 100 IU vial. The minimum, maximum and median prices are calculated over the time period for all countries combined, as well as median prices over the time period, disaggregated by country income group as defined by the World Bank in 2015.

There are no simple solutions for addressing Diabetes but coordinated, multicomponent intervention can make a significant difference.

Researched, collected and written by Zsolt Szemerszky

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