The global diabetes threat

Diabetes is growing to crisis proportions here in the U.S. We are just beginning to recognize its challenge. There is a larger threat, however, one we don't see yet. It is the worldwide epidemic growth of diabetes.

If we can understand this graver challenge soon enough, we may be able to support prevention measures that can contain it. If not, the global costs of diabetes — in dollars and in human suffering — will be staggering.

The current world health challenges of greatest impact are AIDS, malaria and tuberculosis. Every year, they kill more than 6 million people, most in developing countries. But off the radar of public awareness so far is diabetes, lurking unnoticed, yet growing with a frightening trajectory, especially in Asia. It comes with a host of complications fearsome and profound.

Now, it is invisible. When it makes itself manifest, it will explode in heart disease, kidney disease, blindness, stroke, gangrene and death.

The World Health Organization (WHO) is undertaking an energetic program to raise public awareness around the globe about the dimensions of this threat. WHO estimates that in 2000, there were 170 million people worldwide with diabetes. The estimate for 2030 is almost 370 million, more than doubled in 30 years.

Dr. R. Paul Robertson

Especially alarming is the growth of diabetes among the young, where rising rates of obesity worldwide put children at an unprecedented risk for developing the disease.

India and China top the list of countries with the greatest incidence of diabetes now. Together, they account today for more than 50 million cases. By 2030, if effective measures are not put in place soon enough, there will be more than 120 million persons suffering from diabetes in those two countries alone.

WHO's effort, called Diabetes Action Now, is focused on strategic communications aimed primarily at policymakers and government leaders. Substantial research studies have shown — in Finland and the United States, for example — that type 2 diabetes can be prevented or forestalled by behavioral change. Diet, exercise and the elimination of smoking, along with support structures to reinforce these changes, combine to prevent or postpone diabetes in huge numbers of at-risk individuals.

What's needed are public policies that will encourage such changes in individual behavior and the infrastructure to support them. Transportation systems and urban design need to be configured to foster and promote physical exercise. Advertising and food pricing need to be structured to provide the cultural and economic reinforcement to make diet change realistic and affordable.

Dr. Christopher Elias

Because the scope of the problem is so vast, only systemic, populationwide programs can hope to reduce the obesity and physical inactivity that create such risk for diabetes.

Basic research is essential to this program. What's needed is science that clarifies the causes of diabetes and that explores new possibilities for prevention and treatment. Equally important is the translation of this knowledge into clinical practice and public policy. The truth about diabetes and its threat to personal and public health needs to be delivered with cultural sensitivity that will ensure its effectiveness.

We clearly have our work cut out for us at home. It will require a quite dramatic collaboration of science, public education and political advocacy if we're to stem the growth of diabetes here in this country.

But provincial concern shouldn't blind us to the global challenge, which is even more daunting. It will take all the political and diplomatic skill we can marshal and all the scientific creativity we can focus to avert a worldwide public menace that, for now, we cannot even see.

Dr. Christopher Elias is president of PATH (Program for Appropriate Technology in Health), based in Seattle. Dr. R. Paul Robertson is president of PNRI, Pacific Northwest Research Institute, in Seattle.