Diabetes

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Overview

Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves.  It is associated with an absolute or relative deficiency in the secretion and/or action of insulin. It leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. 

There are three main forms of diabetes. Type 2 is the most common, representing 85-90% of all cases, usually in adults, which occurs when the body becomes resistant to insulin or doesn't make enough insulin. In the past three decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels, linked to modifiable factors such as obesity and overweight, physical inactivity and high calories, low nutritional value diets. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy.  For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. 

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

It is estimated that about 62 million people in the Americas live with type 2 diabetes. Both the number of cases and the prevalence of diabetes have risen steadily over the past decades. There is a globally agreed target to halt the rise in diabetes and obesity by 2025.

 

Key facts
  • It is estimated that 62 million of people in the Americas live with Diabetes Mellitus (DM) type2. This number has tripled in the Region since 1980.
  • According to the Diabetes Atlas, the number of people with diabetes will reach the 109 million mark by 2040. 
  • In 2015 Health Expenditures for diabetes in the Americas were estimated at $382.6 billion (or 12-14% of health budget) and this number will increase to $445.6 billion by 2040.
  • Poorly controlled Diabetes increases the chances of premature mortality as well as chronic complications such as cardiovascular diseases, blindness, nephropathy, foot ulcers and amputations. In addition, people with diabetes are at higher risk of presenting tuberculosis, especially those with poor glycemic control.
  • The risk of dying from cardiovascular disease (CVD) and all causes is between two and three times higher among people with diabetes than among their peers without diabetes.
  • The cost of health care for people affected by diabetes is between two and three times higher than among peers without diabetes.
  • While diabetes and its complications are largely preventable, lack of access to quality health care services and lack of knowledge of preventive measures are widespread.
  • Studies have demonstrated that approximately one-third of people with type 2 diabetes are undiagnosed, and already present complications at the time of diagnosis.
  • People at risk for diabetes should be recommended daily consumption of fruit and vegetables, 30-minute physical activity per day and maintaining a healthy weight.
  • People with diabetes should adhere to a healthy lifestyle and medication, if indicated by health provider, to ensure an adequate control of blood glucose.

 

Fact sheet

General recommendations

  • People at risk for diabetes should be recommended daily consumption of fruit and vegetables, 30-minute physical activity per day and maintaining a healthy weight.
  • People with diabetes should adhere to a healthy lifestyle and medication, if indicated by health provider, to ensure an adequate control of blood glucose.

Women and diabetes:

  • In many countries, obesity and diabetes affect women disproportionately. Gestational diabetes in particular has detrimental consequences for both mother and child, increasing the frequency of perinatal morbidity and mortality. In addition, maternal obesity and diabetes have been linked to increased susceptibility for the child to develop diabetes during their youth, creating a vicious circle.
  • Diabetes also affects other health conditions; because it impairs immunity, for example, diabetes has been associated with tuberculosis. The relationship among diabetes, maternal and newborn morbidity and tuberculosis may have a negative impact on the achievement of the related Millennium Development Goals in many countries of the Region. Furthermore, low birth weight is associated with an increased risk for type 2 diabetes during adulthood. This may exacerbate the diabetes epidemic in low and middle income countries that are still struggling with a high frequency of low birth weight.

Obesity as a precursor to diabetes:

  • The obesity epidemic, which is linked to the rise in diabetes, is largely driven by the twin trends of changing dietary patterns and decreasing physical activity. Most countries in the Americas are experiencing a shift in dietary patterns toward increased consumption of energy-dense foods, rich in saturated fat, sugars, and salt. This pattern, coupled with the fact that 30 to 60% of the population does not meet minimum recommended levels of physical activity (e.g., 30 minutes walking per day) contribute in large part to the high rates of overweight persons and obesity in the Region.
  • Adults are considered overweight if they have a body mass index (BMI) between 25 kg/m2 and 29.9 Kg/m2 and considered obese if their BMI is above 30 Kg/m2. Research has demonstrated a strong and consistent link between obesity and diabetes; increases in BMI are associated with increased risk for diabetes and abdominal obesity has emerged as a strong predictor of diabetes.
  • Environmental changes are the major contributors to the aforementioned changes in diet and physical activity patterns. A combination of government policies, regional and global market forces, inadequate response to changing demographic patterns, technological advances that precipitate behavior and lifestyle changes, and lack of awareness and action by civil society are key factors leading to the rising epidemics of obesity and diabetes. However, the strong social and environmental determinants of obesity and ill health provide an important area for intervention with strong evidence-based data to guide action.

 

Interventions for the prevention and management of diabetes and obesity:

  • Prevention and management strategies are crucial to turn back the tide regarding obesity and diabetes. Evidence demonstrates that risks of chronic disease begin in the uterus and continue into old age. Therefore, strategies to address the problem at all stages of the life cycle are important, including paying particular attention to obesity and diabetes in women of reproductive age.
  • The frequency of medical care and health expenditures among those with diabetes increases as early as eight years before clinical onset of the disease. This means that persons at the highest risk for type 2 diabetes are often already in contact with the health system and can be easily identified. People with prediabetes have been shown to have increased risk for diabetes and cardiovascular diseases. Diabetes screening facilities are the opportune identification point for such at-risk individuals, or for those in the early stages of obesity and diabetes, when non-pharmacological treatment may still be a preferred option. Studies have demonstrated that approximately one-third of people with type 2 diabetes are undiagnosed, and already present complications at the time of diagnosis. 
  • Two approaches need to be used to implement prevention strategies: the population-based approach and the individual, high-risk approach. The individual approach focuses on high-risk or affected individuals through direct interventions.
  • The population and individual approaches are complementary and function best when combined in an integrated manner.

Key actions:

  • Promote universal access to care - Universal access to health care to ensure diabetes prevention and control programs reach all sectors of the population especially those with limited resources and increased risk of type 2 diabetes.
  • Primary prevention of type 2 diabetes - Primary prevention at the population and individual level through activities such as health promotion, creation of healthy public policies focused on food, diet and physical activity, and creation of healthy environments. Make diabetes screening and prevention programs available at the first level of care so people at risk can be detected and provide guidance to prevention programs.
  • Screening for type 2 diabetes and Impaired Fasting Glucose/Impaired Glucose Tolerance - Identification of people at risk for diabetes (with two or more risk factors for type 2 diabetes (such as a family history of diabetes, high blood pressure, a history of hyperglycemia or gestational diabetes, or overweight) where preventive services are available.
  • Improving the management of diabetes - Standards for care and management of obesity and diabetes should be developed and implemented at the primary care level. The chronic care model is a framework to identify gaps in care with the aim of designing strategies for quality improvement. The creation of community programs within the civil society can provide additional support to people with obesity and diabetes.
  • Secondary prevention of complications - Strategies include patient and provider education, efforts aimed at smoking cessation, increased physical activity, and healthy eating. A number of clinically proven strategies are available for the secondary prevention of complications such as CVD, nephropathy, retinopathy, blindness and amputations. The WHO package of Essential NCD Interventions in Primary Health Care (WHO — PEN) provides treatment protocols, referral criteria, an affordable list of essential medicines and technologies and templates for record keeping in primary health care.
  • Surveillance and monitoring - Various sources of information can be used for the surveillance of diabetes and obesity in populations, including periodical population-based surveys using the WHO Steps method, health service statistics, school-based surveys and routinely collected vital statistics.
  • Health policies - Use fiscal, regulatory and other government powers to create environments that make the healthy choice the easier choice to make. This includes, for example, increasing taxes to reduce consumption of sugar-sweetened soda; banning advertising of unhealthy foods to children along with the sale of these foods in schools; and promoting public transportation and recreational spaces to encourage urban residents to be more physically active.
What PAHO does

PAHO/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, PAHO/WHO:

  • provides scientific guidelines for the prevention of major noncommunicable diseases 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); and
  • conducts surveillance of diabetes and its risk factors.

The WHO "Global report on diabetes" provides an overview of the diabetes burden, 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 and obesity.

The WHO  module on diagnosis and management of type 2 diabetes brings together  guidance on diagnosis, classification and management of type 2 diabetes in one document. The module will be useful to policy makers who plan service delivery of  diabetes care, national programme managers responsible for training, planning and monitoring service delivery, and facility managers and primary care staff  involved in clinical care and monitoring processes and outcomes of diabetes care.