Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.
A change in fortune can also bring changes in disease patterns and risks. The global health community now recognizes the increasing burden in developing countries of diabetes and other non-communicable diseases, which are often viewed as diseases of affluent countries.
Today is World Diabetes Day. Asia is one region with a big and burgeoning diabetes problem. In many low- and middle-income Asian countries, people are living longer than ever before, and economies are growing rapidly. These positive developments also help fuel a rising burden of non-communicable diseases.
As the burden of diseases traditionally associated with wealthy nations grows in poorer nations, many people living in these countries lack access to the standards of health care enjoyed by those living in more prosperous areas. The treatment of non-communicable diseases such as diabetes is generally more expensive than treatment of communicable diseases, in part due to the long-term follow-up required to manage many of these conditions.
Even with access to high-quality medical care, blood sugar monitoring devices, and medicine, controlling diabetes can be a challenge. Without these essential tools, it is nearly impossible. A 2011 article from the IRIN news agency shed light on the potential consequences of uncontrolled diabetes. The article featured the story of a Cambodian motorcycle taxi driver, age 46, who broke his leg and had to have it amputated as a result of complications from diabetes. In addition to increasing the risk of amputation, uncontrolled diabetes can cause heart disease and stroke, nerve damage, kidney failure, and blindness.
In Southeast Asia, for example, early death and disability from diabetes (also known as DALYs, or disability-adjusted life years) increased by 100% between 1990 and 2010 and rose in rank from the 18th leading cause in 1990 to the 9th leading cause in 2010 as shown in the screen shot below. The burden of diabetes increased in East Asia, where the regional disease pattern is dominated by China, and South Asia, which is dominated by India. You can view the results for these regions or for different countries via the Global Burden of Disease online data visualization tools here and here.
When compared to other causes of premature death and disability, diabetes is a dominant cause in certain Southeast Asian countries and is less prominent in others. The screen grab below shows that diabetes was the third-highest cause of disease burden in Sri Lanka and ranked among the top ten causes of disease burden in Indonesia, Malaysia, and Thailand in 2010. In contrast, diabetes was among the top 20 causes of early death and disability in the most of the other Southeast Asian countries shown in the screen grab. You can use this tool to explore rankings of the leading causes of disease burden in other countries and regions (click here to see countries in East Asia and South Asia).
Next, we’ll explore rates of early death and disability from diabetes across different developing and developed countries in Asia. After adjusting for differences in population size, Indonesia, the Philippines, and Sri Lanka have the highest rates of diabetes among the different countries shown in the screen grab, surpassing high-income countries such as Taiwan, South Korea, Singapore, and Japan.
I asked GBD co-author Professor Theo Vos to describe the different factors that are contributing to trends in diabetes in Asian countries.
“In Indonesia and Thailand,” said Vos, “High body mass index is a major driver of the growing burden of diabetes. But some of the variation in diabetes in different Asian countries is not explained by obesity.”
“There is a compelling hypothesis, known as the “Barker hypothesis,” that exposure to nutritional deprivation in the womb during early pregnancy can raise the risk of non-communicable diseases such as diabetes and heart disease later in life.” Lack of nutrition in the womb along with overeating as an adult was recently cited in a Bloomberg article as a possible factor for the growing diabetes epidemic in China.
Exploring disease burden from diabetes in low-and middle-income Asian countries illustrates the complexity of addressing both the symptoms and the risk factors for non-communicable diseases in developing countries. Above all, it underscores the importance of universal access to effective health care for managing chronic conditions such as diabetes.