World Health Day 2016: WHO calls for global action to halt rise in and improve care for people with diabetes

First WHO Global report on diabetes: 422 million adults live with diabetes, mainly in developing countries

6 APRIL, 2016 | GENEVA – The number of people living with diabetes has almost quadrupled since 1980 to 422 million adults, with most living in developing countries. Factors driving this dramatic rise include overweight and obesity, WHO announced ahead of World Health Day.

WHO is marking its annual World Health Day (7 April), which celebrates the Organization’s founding in 1948, by issuing a call for action on diabetes. In its first “Global report on diabetes”, WHO highlights the need to step up prevention and treatment of the disease.

Health-promoting environments reduce risk factors

Measures needed include expanding health-promoting environments to reduce diabetes risk factors, like physical inactivity and unhealthy diets, and strengthening national capacities to help people with diabetes receive the treatment and care they need to manage their conditions.

“If we are to make any headway in halting the rise in diabetes, we need to rethink our daily lives: to eat healthily, be physically active, and avoid excessive weight gain,” says Dr Margaret Chan, WHO Director-General. “Even in the poorest settings, governments must ensure that people are able to make these healthy choices and that health systems are able to diagnose and treat people with diabetes.”

Diabetes is a chronic, progressive noncommunicable disease (NCD) characterized by elevated levels of blood glucose (blood sugar). It occurs either when the pancreas does not produce enough of the insulin hormone, which regulates blood sugar, or when the body cannot effectively use the insulin it produces.

Key findings from WHO’s “Global report on diabetes”

Among the key findings from the “Global report on diabetes” are:

• The number of people living with diabetes and its prevalence are growing in all regions of the world. In 2014, 422 million adults (or 8.5% of the population) had diabetes, compared with 108 million (4.7%) in 1980.
• The epidemic of diabetes has major health and socioeconomic impacts, especially in developing countries.
• In 2014, more than 1 in 3 adults aged over 18 years were overweight and more than one in 10 were obese.
• The complications of diabetes can lead to heart attack, stroke, blindness, kidney failure and lower limb amputation. For example, rates of lower limb amputation are 10 to 20 times higher for people with diabetes.
• 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.
• Many of these deaths (43%) occur prematurely, before the age of 70 years, and are largely preventable through adoption of policies to create supportive environments for healthy lifestyles and better detection and treatment of the disease.
• Good management includes use of a small set of generic medicines; interventions to promote healthy lifestyles; patient education to facilitate self-care; and regular screening for early detection and treatment of complications.

Global commitments to reduce diabetes

“Many cases of diabetes can be prevented, and measures exist to detect and manage the condition, improving the odds that people with diabetes live long and healthy lives,” says Dr Oleg Chestnov, WHO’s Assistant Director-General for NCDs and Mental Health. “But change greatly depends on governments doing more, including by implementing global commitments to address diabetes and other NCDs.”

These include meeting Sustainable Development Goal (SDG) target 3.4, which calls for reducing premature death from NCDs, including diabetes, by 30% by 2030. Governments have also committed to achieving 4 time-bound national commitments set out in the 2014 UN General Assembly “Outcome Document on Noncommunicable Diseases”, and attaining the 9 global targets laid out in the WHO “Global Action Plan for the Prevention and Control of NCDs”, which include halting the rise in diabetes and obesity.

“Around 100 years after the insulin hormone was discovered, the “Global report on diabetes” shows that essential diabetes medicines and technologies, including insulin, needed for treatment are generally available in only 1 in 3 of the world’s poorest countries,” says Dr Etienne Krug, Director of WHO’s Department for the Management of NCDs, Disability, Violence and Injury Prevention. “Access to insulin is a matter of life or death for many people with diabetes. Improving access to insulin and NCD medicines in general should be a priority.”

Global efforts are underway to make medicines, including for NCDs, more available and affordable. Commitments from world leaders, including the SDGs, the 2011 “UN Political Declaration on the Prevention and Control of Noncommunicable Diseases”, the 2014 UN General Assembly “Outcome Document on Noncommunicable Diseases”, and the work of the UN Secretary-General’s high-level panel on access to essential medicines are aimed at improving affordability and availability of essential drugs for people living with diabetes.

Note to editors

There are three main forms of diabetes: type 1, type 2 and gestational diabetes. The cause of type 1 diabetes is unknown and people living with it require daily insulin administration for survival. Type 2 accounts for the vast majority of people living with diabetes globally, and is largely the result of excess body weight and physical inactivity. Once seen only in adults, type 2 diabetes is now increasingly occurring in children and young people. Gestational diabetes is a temporary condition that occurs in pregnancy and carries long-term risk of type 2 diabetes. Gestational diabetes is present when blood glucose values are above normal but still below those diagnostic of diabetes.

Diabetes

Key facts

• The number of people with diabetes has risen from 108 million in 1980 to 422 million in 20141.
• The global prevalence of diabetes* among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 20141.
• Diabetes prevalence has been rising more rapidly in middle- and low-income countries1.
• Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation1.
• In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to high blood glucose**1.
• Almost half of all deaths attributable to high blood glucose occur before the age of 70 years1. WHO projects that diabetes will be the 7th leading cause of death in 2030 2.
• Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes1.
• Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications1.

What is diabetes?

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar 3. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels 3.

In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2012 diabetes was the direct cause of 1.5 million deaths and high blood glucose was the cause of another 2.2 million deaths1.

Type 1 diabetes

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin 3. The cause of type 1 diabetes is not known and it is not preventable with current knowledge.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.

Type 2 diabetes

Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin 3. Type 2 diabetes comprises the majority of people with diabetes around the world 3, and is largely the result of excess body weight and physical inactivity.

Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.

Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children.

Gestational diabetes

Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy 4. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They and their children are also at increased risk of type 2 diabetes in the future.

Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms.

Impaired glucose tolerance and impaired fasting glycaemia

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes 3. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.

What are common consequences of diabetes?

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves:

• Adults with diabetes have a 2-3-fold increased risk of heart attacks and strokes 5.
• Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection and eventual need for limb amputation.
• Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes 6.
• Diabetes is among the leading causes of kidney failure 7.

How can the burden of diabetes be reduced?

Prevention

Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:

• achieve and maintain healthy body weight;
• be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;
• eat a healthy diet, avoiding sugar and saturated fats intake; and
• avoid tobacco use – smoking increases the risk of diabetes and cardiovascular diseases.

Diagnosis and treatment

Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar.

Treatment of diabetes involves diet and physical activity along with lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.

Interventions that are both cost-saving and feasible in developing countries include8:

• blood glucose control, particularly in type 1 diabetes. People with type 1 diabetes require insulin, people with type 2 diabetes can be treated with oral medication, but may also require insulin;
• blood pressure control; and
• foot care.

Other cost saving interventions include:

• screening and treatment for retinopathy (which causes blindness);
• blood lipid control (to regulate cholesterol levels);
• screening for early signs of diabetes-related kidney disease and treatment.

WHO response

WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low and middle-income countries. To this end, WHO:

• provides scientific guidelines for the prevention of major NCDs including diabetes;
• develops norms and standards for diabetes diagnosis and care;
• builds awareness on the global epidemic of diabetes, marking World Diabetes Day (14 November);
• conducts surveillance of diabetes and its risk factors.

The “WHO Global report on diabetes” provides an overview of the diabetes burden, the interventions available to prevent and manage diabetes, and recommendations for governments, individuals, the civil society and the private sector.

The WHO “Global strategy on diet, physical activity and health” complements WHO’s diabetes work by focusing on population-wide approaches to promote healthy diet and regular physical activity, thereby reducing the growing global problem of overweight people and obesity.

For more information please contact:

Paul Garwood Telephone: 41 22 791 1578 Mobile: 41 79 603 7294 Email:

Laura Sminkey Telephone: 41 22 791 4547 Mobile: 41 79 249 3520 Email: