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Diabetes

A SILENT KILLER

One in every 11 adults has diabetes

415 million

 

 

China and India have the highest number of people with diabetes — 110 million and 69 million, respectively — whereas the highest prevalence was found in the Pacific Islands of Tokelu and Nauru, where 30 per cent and 24 per cent of all adults are estimated to be living with diabetes.

 

 


children under the age of 15 suffering from type 1 diabetes in India

70,000

Another 40,000 have been diagnosed with Type 2 diabetes and this figure is growing by 5 per cent each year.


Every 6 seconds, a person dies from diabetes

5 million deaths

The number of diabetes cases has climbed 4.4 per cent over the past two years and is more than 5 per cent of the world’s population.


One in 7 births is affected by

gestational diabetes

More than 20.9 million live births were affected by diabetes during pregnancy in 2015.


What is diabetes?


DIABETES | ACROSS THE GLOBE

 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 obesity

According to a Lancet study, China, India and USA are among the top three countries with a high number of diabetic patients. While the numbers climbed from 20.4 million in China in 1980 to 102.9 million in 2014, the rise has been equally dramatic in India from 11.9 million in 1980 to 64.5 million in 2014. Prevalence of diabetes has more than doubled for men in India and China (3.7 per cent to 9.1 per cent in India and 3.5 per cent to 9.9 per cent in China). It has also increased by 50 per cent among women in China (5 per cent to 7.6 per cent) and 80 per cent among women in India (4.6 per cent to 8.3 per cent).

 

IN AFRICA

In Africa, more than two thirds of the population with diabetes are undiagnosed

An estimated 14.2 (9.5-29.4‡) million adults aged 20-79 have diabetes in the Africa Region, representing a regional prevalence of 2.1-6.7 per cent‡. The Africa Region has the highest proportion of undiagnosed diabetes; over two thirds (66.7 per cent) of people with diabetes are unaware that they have the disease.

The majority (58.8 per cent) of people with diabetes live in cities, even though the population in the region is predominantly (61.3 per cent) rural. Diabetes in adults is in general much higher on islands in the Africa Region, compared to the mainland.

The highest prevalence is found in the Seychelles (17.4 per cent age-adjusted comparative prevalence, 17.4 per cent raw prevalence), followed by the island of Reunion (15.8 per cent age-adjusted, 18.2 per cent raw) and Comoros (9.9 per cent age-adjusted, 7.5 per cent raw). Some of Africa’s most populous countries have the highest numbers of people with diabetes, including South Africa (2.3 [1.2-4.6‡] million), Democratic Republic of Congo (1.8 [1.5-2.2‡] million), Nigeria (1.6 [1.2-3.8‡] million) and Ethiopia (1.3 [0.8-3.5‡] million). Nearly half of all adults with diabetes in the region live in these four countries


IN AMERICA

One adult in eight has diabetes in the North America and Caribbean regions.

With 12.9 per cent (10.8-14.5 per cent‡) of the adult population affected, the North America and Caribbean Region has the highest prevalence of diabetes compared to the other IDF regions. An estimated 44.3 (37.1-49.9‡) million people with diabetes aged 20-79 lived in the region in 2015, of which 13.3 million (29.9 per cent) are undiagnosed. The vast majority of people with diabetes (82.6 per cent) are living in urban areas.
Most of the people in the region live in the US, Mexico and Canada, which also account for the large majority of the number of people with diabetes. Over 92 per cent of the countries and territories in the region have an age-adjusted comparative diabetes prevalence rate above the global average (8.8 per cent), with Canada and Haiti being the only exceptions at 7.4 per cent and 6.9 per cent respectively


IN Europe

Europe has the highest prevalence of children with Type 1 diabetes

The number of people with diabetes is estimated to be 59.8 (45.1-85.6‡) million (9.1 per cent [6.8-13.0 per cent‡] of the population aged 20-79), including 23.5 million undiagnosed cases. While the Europe Region has the second-lowest age-adjusted comparative diabetes prevalence rate of any IDF region (after the Africa Region) there are still many countries with relatively high diabetes prevalence rates.

Turkey has the highest age-adjusted comparative prevalence (12.8 per cent comparative prevalence, 12.5 per cent raw prevalence) and the third-highest number of people with diabetes in the Europe Region (6.3 [5.7-7.5‡] million), after Germany (6.5 [5.9-7.5‡] million) and the Russian Federation (12.1 [6.2-17.0‡] million).


IN South East Asia

One quarter of all births are affected by high blood glucose during pregnancy in Southeast Asia.

Estimates in 2015 indicate that 8.5 per cent (6.8-10.8%‡) of the adult population has diabetes. This is equivalent to 78.3 (62.9 to 100.4‡) million people living with diabetes. Over half (52.1 per cent) of these are undiagnosed. Although only one third (32.5 per cent) of adults in the Southeast Asia Region lived in urban areas in 2015, nearly half (47.5 per cent) of all adults with diabetes can be found in cities.
India is home to the second largest number of children with Type 1 diabetes in the world (70,200), after the US, and accounts for the majority of the children with Type 1 diabetes in the region. The incidence rate for Type 1 diabetes in India was used to extrapolate figures for other similar countries, and therefore plays a pivotal role in the regional and global estimates.


IN Western Pacific Region

37 per cent of all adults with diabetes live in the Western Pacific region.

In 2015, 9.3 per cent (8.2-11.4 per cent ‡) of adults aged 20-79 are estimated to be living with diabetes.

This is equivalent to 153 (135-188‡) million people. Over half (52.1 per cent) of these are undiagnosed, 61.6 per cent live in cities and 90.2 per cent live in low- or middle-income countries. The Western Pacific Region is home to 36.9 per cent of the total number of people with diabetes in the world.


DIABETES | HEALTH EXPENDITURE

12 per cent of global health expenditure

$673 billion

 Diabetes imposes a large economic burden on the national healthcare system. 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 covered in this report were estimated to spend 5 per cent or more, and about 80 per cent of the countries were estimated to spend between 5 per cent and 13 per cent of their total healthcare dollars on diabetes.

Global health expenditures to prevent and treat diabetes and its complications were expected to total at least $376 billion in 2010. By 2030, this number will exceed some $490 billion. An average of $703 per person were estimated to be spent on diabetes in 2010 globally.

Health expenditure on diabetes in India

India, the country with the largest population of people living with diabetes, will spend an estimated $2.8 billion, or less than 1 per cent of the global total. The current expenditure on diabetes treatment in India is approximately $95 (Rs 6,000) person/annum as per the IDF atlas, 2014, whereas the cost of treatment of one complication of diabetes such as, treating the diabetic foot is around Rs 10,000 – 30,000 per treatment. With the huge number of diabetes patients and complications we are dealing with, overall health expenditure per person is much less as compared to the developed countries. An average of $7,383 per person with diabetes will be spent on diabetes-related care in the US but less than $10 per person will be spent in Burundi, Côte d’Ivoire and Myanmar.


 

DIABETES | Symptoms & complications

How can you tell if you have diabetes? Most early symptoms are from higher-than-normal levels of glucose, a kind of sugar, in your blood. The warning signs can be so mild that you don’t notice them. That’s especially true of Type 2 diabetes. Some people don’t find out they have it until they get problems from long-term damage caused by the disease.

With Type 1 diabetes, the symptoms usually happen quickly, in a matter of days or a few weeks. They’re much more severe, too.

Other Type 1 symptoms

Nausea and vomiting. When your body resorts to burning fat, it makes “ketones.” These can build up in your blood to dangerous levels, a possibly life-threatening condition called diabetic ketoacidosis. Ketones can make you feel sick to your stomach.


Complications

Diabetes increases your risk for many serious health problems. What’s the good news? With correct treatment and recommended lifestyle changes, many people with diabetes are able to prevent or delay the onset of complications.

It’s hard to ignore the signs of Type 1 diabetes because symptoms can often appear quite quickly. But leaving it untreated can lead to serious health problems, including diabetic ketoacidosis, which can result in a potentially fatal coma.

Type 2 diabetes can be easier to miss as it develops more slowly, especially in the early stages when it can be harder to spot the symptoms. But untreated diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Being diagnosed early and controlling your blood sugar levels can help prevent these complications


DIABETES | Prevention & solution

70 per cent

Diabetes could be prevented by healthy lifestyle.

 Diabetes imposes a large economic burden on the national healthcare system. Healthcare expenditures on diabetes will account for 11.6 per cent of the total healthcare expenditure in the world in 2010. About 95 per cent of the countries covered in this report will spend 5 per cent or more, and about 80 per cent of the countries will spend between 5 per cent and 13 per cent of their total healthcare dollars on diabetes.

1. Maintain a healthy diet

The right meal plan will help you improve your blood glucose, blood pressure, and cholesterol numbers and also help keep your weight on track. Whether you need to lose weight or stay where you are, your meal plan can help.

There is no one perfect food so including a variety of different foods and watching portion sizes is key to a healthy diet. Also, make sure your choices from each food group provide the highest quality nutrients you can find. In other words, pick foods rich in vitamins, minerals and fibre over those that are processed.

2. Quit your sedentary lifestyle

The incidence of Type 2 diabetes is rapidly increasing worldwide due to the increasing occurrence of obesity and sedentary lifestyle. Type 2 diabetes is no longer confined to middle-aged and elderly people, but is increasingly common among young people and even children. Type 2 diabetes constitutes a major health problem in both developed and developing countries, and with obesity, it is becoming one of the largest challenges to health care systems. Therefore, any measures to prevent or delay the development of diabetes are urgently needed.

A February 2013 study published in the International Journal of Behavioral Nutrition and Physical Activity in surveyed 63,048 middle-aged Australian men about how long they sit during an average day as well as diagnoses of any chronic diseases, including Type 2 diabetes. The responses spanned from less than four hours to more than eight hours of sitting a day.

3. Keep weight under control

Physical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also helps your body use insulin more efficiently.

These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts. But even light activities — such as housework, gardening or being on your feet for extended periods — can improve your blood sugar level.

4. No smoking, no alcohol

People with diabetes who smoke have higher blood-sugar levels and less control over their blood-sugar levels than non-smokers with diabetes. Smoking affects circulation by increasing heart rate and blood pressure and by making small blood vessels narrower. Smoking also makes blood cells and blood-vessel walls sticky, and allows dangerous fatty material to build up. This can lead to heart attack, stroke and other blood vessel diseases.

Young adult smokers with diabetes are two to three times more likely to be sick than non-smokers with diabetes.

The liver normally releases stored sugar to counteract falling blood sugar levels. But if your liver is busy metabolising alcohol, your blood sugar level may not get the boost it needs from the liver. Alcohol can result in low blood sugar shortly after you drink it and for as many as 24 hours more.

 

 

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  • The United Nations has shaped so much of global co-operation and regulation that we wouldn’t recognise our world today without the UN’s pervasive role in it. So many small details of our lives – such as postage and copyright laws – are subject to international co-operation nurtured by the UN.

    In its 75th year, however, the UN is in a difficult moment as the world faces climate crisis, a global pandemic, great power competition, trade wars, economic depression and a wider breakdown in international co-operation.

    Flags outside the UN building in Manhattan, New York.

    Still, the UN has faced tough times before – over many decades during the Cold War, the Security Council was crippled by deep tensions between the US and the Soviet Union. The UN is not as sidelined or divided today as it was then. However, as the relationship between China and the US sours, the achievements of global co-operation are being eroded.

    The way in which people speak about the UN often implies a level of coherence and bureaucratic independence that the UN rarely possesses. A failure of the UN is normally better understood as a failure of international co-operation.

    We see this recently in the UN’s inability to deal with crises from the ethnic cleansing of the Rohingya Muslims in Myanmar, to civil conflict in Syria, and the failure of the Security Council to adopt a COVID-19 resolution calling for ceasefires in conflict zones and a co-operative international response to the pandemic.

    The UN administration is not primarily to blame for these failures; rather, the problem is the great powers – in the case of COVID-19, China and the US – refusing to co-operate.

    Where states fail to agree, the UN is powerless to act.

    Marking the 75th anniversary of the official formation of the UN, when 50 founding nations signed the UN Charter on June 26, 1945, we look at some of its key triumphs and resounding failures.


    Five successes

    1. Peacekeeping

    The United Nations was created with the goal of being a collective security organisation. The UN Charter establishes that the use of force is only lawful either in self-defence or if authorised by the UN Security Council. The Security Council’s five permanent members, being China, US, UK, Russia and France, can veto any such resolution.

    The UN’s consistent role in seeking to manage conflict is one of its greatest successes.

    A key component of this role is peacekeeping. The UN under its second secretary-general, the Swedish statesman Dag Hammarskjöld – who was posthumously awarded the Nobel Peace prize after he died in a suspicious plane crash – created the concept of peacekeeping. Hammarskjöld was responding to the 1956 Suez Crisis, in which the US opposed the invasion of Egypt by its allies Israel, France and the UK.

    UN peacekeeping missions involve the use of impartial and armed UN forces, drawn from member states, to stabilise fragile situations. “The essence of peacekeeping is the use of soldiers as a catalyst for peace rather than as the instruments of war,” said then UN Secretary-General Javier Pérez de Cuéllar, when the forces won the 1988 Nobel Peace Prize following missions in conflict zones in the Middle East, Africa, Asia, Central America and Europe.

    However, peacekeeping also counts among the UN’s major failures.

    2. Law of the Sea

    Negotiated between 1973 and 1982, the UN Convention on the Law of the Sea (UNCLOS) set up the current international law of the seas. It defines states’ rights and creates concepts such as exclusive economic zones, as well as procedures for the settling of disputes, new arrangements for governing deep sea bed mining, and importantly, new provisions for the protection of marine resources and ocean conservation.

    Mostly, countries have abided by the convention. There are various disputes that China has over the East and South China Seas which present a conflict between power and law, in that although UNCLOS creates mechanisms for resolving disputes, a powerful state isn’t necessarily going to submit to those mechanisms.

    Secondly, on the conservation front, although UNCLOS is a huge step forward, it has failed to adequately protect oceans that are outside any state’s control. Ocean ecosystems have been dramatically transformed through overfishing. This is an ecological catastrophe that UNCLOS has slowed, but failed to address comprehensively.

    3. Decolonisation

    The idea of racial equality and of a people’s right to self-determination was discussed in the wake of World War I and rejected. After World War II, however, those principles were endorsed within the UN system, and the Trusteeship Council, which monitored the process of decolonisation, was one of the initial bodies of the UN.

    Although many national independence movements only won liberation through bloody conflicts, the UN has overseen a process of decolonisation that has transformed international politics. In 1945, around one third of the world’s population lived under colonial rule. Today, there are less than 2 million people living in colonies.

    When it comes to the world’s First Nations, however, the UN generally has done little to address their concerns, aside from the non-binding UN Declaration on the Rights of Indigenous Peoples of 2007.

    4. Human rights

    The Human Rights Declaration of 1948 for the first time set out fundamental human rights to be universally protected, recognising that the “inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world”.

    Since 1948, 10 human rights treaties have been adopted – including conventions on the rights of children and migrant workers, and against torture and discrimination based on gender and race – each monitored by its own committee of independent experts.

    The language of human rights has created a new framework for thinking about the relationship between the individual, the state and the international system. Although some people would prefer that political movements focus on ‘liberation’ rather than ‘rights’, the idea of human rights has made the individual person a focus of national and international attention.

    5. Free trade

    Depending on your politics, you might view the World Trade Organisation as a huge success, or a huge failure.

    The WTO creates a near-binding system of international trade law with a clear and efficient dispute resolution process.

    The majority Australian consensus is that the WTO is a success because it has been good for Australian famers especially, through its winding back of subsidies and tariffs.

    However, the WTO enabled an era of globalisation which is now politically controversial.

    Recently, the US has sought to disrupt the system. In addition to the trade war with China, the Trump Administration has also refused to appoint tribunal members to the WTO’s Appellate Body, so it has crippled the dispute resolution process. Of course, the Trump Administration is not the first to take issue with China’s trade strategies, which include subsidises for ‘State Owned Enterprises’ and demands that foreign firms transfer intellectual property in exchange for market access.

    The existence of the UN has created a forum where nations can discuss new problems, and climate change is one of them. The Intergovernmental Panel on Climate Change (IPCC) was set up in 1988 to assess climate science and provide policymakers with assessments and options. In 1992, the UN Framework Convention on Climate Change created a permanent forum for negotiations.

    However, despite an international scientific body in the IPCC, and 165 signatory nations to the climate treaty, global greenhouse gas emissions have continued to increase.

    Under the Paris Agreement, even if every country meets its greenhouse gas emission targets we are still on track for ‘dangerous warming’. Yet, no major country is even on track to meet its targets; while emissions will probably decline this year as a result of COVID-19, atmospheric concentrations of greenhouse gases will still increase.

    This illustrates a core conundrum of the UN in that it opens the possibility of global cooperation, but is unable to constrain states from pursuing their narrowly conceived self-interests. Deep co-operation remains challenging.

    Five failures of the UN

    1. Peacekeeping

    During the Bosnian War, Dutch peacekeeping forces stationed in the town of Srebrenica, declared a ‘safe area’ by the UN in 1993, failed in 1995 to stop the massacre of more than 8000 Muslim men and boys by Bosnian Serb forces. This is one of the most widely discussed examples of the failures of international peacekeeping operations.

    On the massacre’s 10th anniversary, then UN Secretary General Kofi Annan wrote that the UN had “made serious errors of judgement, rooted in a philosophy of impartiality”, contributing to a mass murder that would “haunt our history forever”.

    If you look at some of the other infamous failures of peacekeeping missions – in places such as Rwanda, Somalia and Angola – ­it is the limited powers given to peacekeeping operations that have resulted in those failures.

    2. The invasion of Iraq

    The invasion of Iraq by the US in 2003, which was unlawful and without Security Council authorisation, reflects the fact that the UN is has very limited capacity to constrain the actions of great powers.

    The Security Council designers created the veto power so that any of the five permanent members could reject a Council resolution, so in that way it is programmed to fail when a great power really wants to do something that the international community generally condemns.

    In the case of the Iraq invasion, the US didn’t veto a resolution, but rather sought authorisation that it did not get. The UN, if you go by the idea of collective security, should have responded by defending Iraq against this unlawful use of force.

    The invasion proved a humanitarian disaster with the loss of more than 400,000 lives, and many believe that it led to the emergence of the terrorist Islamic State.

    3. Refugee crises

    The UN brokered the 1951 Refugee Convention to address the plight of people displaced in Europe due to World War II; years later, the 1967 Protocol removed time and geographical restrictions so that the Convention can now apply universally (although many countries in Asia have refused to sign it, owing in part to its Eurocentric origins).

    Despite these treaties, and the work of the UN High Commission for Refugees, there is somewhere between 30 and 40 million refugees, many of them, such as many Palestinians, living for decades outside their homelands. This is in addition to more than 40 million people displaced within their own countries.

    While for a long time refugee numbers were reducing, in recent years, particularly driven by the Syrian conflict, there have been increases in the number of people being displaced.

    During the COVID-19 crisis, boatloads of Rohingya refugees were turned away by port after port.  This tragedy has echoes of pre-World War II when ships of Jewish refugees fleeing Nazi Germany were refused entry by multiple countries.

    And as a catastrophe of a different kind looms, there is no international framework in place for responding to people who will be displaced by rising seas and other effects of climate change.

    4. Conflicts without end

    Across the world, there is a shopping list of unresolved civil conflicts and disputed territories.

    Palestine and Kashmir are two of the longest-running failures of the UN to resolve disputed lands. More recent, ongoing conflicts include the civil wars in Syria and Yemen.

    The common denominator of unresolved conflicts is either division among the great powers, or a lack of international interest due to the geopolitical stakes not being sufficiently high.  For instance, the inaction during the Rwandan civil war in the 1990s was not due to a division among great powers, but rather a lack of political will to engage.

    In Syria, by contrast, Russia and the US have opposing interests and back opposing sides: Russia backs the government of the Syrian dictator Bashar al-Assad, whereas the US does not.

    5. Acting like it’s 1945

    The UN is increasingly out of step with the reality of geopolitics today.

    The permanent members of the Security Council reflect the division of power internationally at the end of World War II. The continuing exclusion of Germany, Japan, and rising powers such as India and Indonesia, reflects the failure to reflect the changing balance of power.

    Also, bodies such as the IMF and the World Bank, which are part of the UN system, continue to be dominated by the West. In response, China has created potential rival institutions such as the Asian Infrastructure Investment Bank.

    Western domination of UN institutions undermines their credibility. However, a more fundamental problem is that institutions designed in 1945 are a poor fit with the systemic global challenges – of which climate change is foremost –  that we face today.