orld Diabetes Day is observed every year on November 14, the birth date of Sir Frederick Banting, who discovered insulin along with Charles Best in 1922. It is the world’s most extensive diabetes awareness campaign, reaching a global audience of over one billion people in more than 160 countries.

Diabetes mellitus is one of the most prevalent public health concerns globally. It is a disorder of carbohydrate metabolism in which the blood glucose level is chronically high due to impaired insulin secretion or action. It has two types: Type 1, which occurs in childhood and is usually mediated by immune mechanisms, and Type 2, which occurs later in life, particularly with advancing age due to diseases of the pancreas.

Approximately 463 million adults worldwide have diabetes; 90 percent of these people suffer from Type 2 diabetes mellitus.

According to an article published in the Annals of Medicine and Surgery in 2022, Pakistan ranks third in the world in diabetes prevalence after China and India. According to the International Diabetes Federation, in 2022, 26.7 percent of adults in Pakistan are affected by diabetes, making the total number of cases approximately 33 million. This number is alarmingly high. It is also growing with each passing year. However, actual numbers are believed to be still higher as many people go undiagnosed till they land up in hospitals with complications.

According to the World Health Organisation, diabetes was the largest cause of mortality in 2019, taking approximately 1.5 million lives. Pakistan is one of the countries most vulnerable to diabetes-related deaths.

Why is diabetes highly prevalent in Pakistan?

Factors that predispose individuals, especially adults, to develop diabetes are mainly genetics and lifestyle changes. These include obesity, a sedentary lifestyle and the intake of large amounts of processed food with high sugar content. The high prevalence of generalised and central obesity predisposes our nation to develop diabetes. The shift from natural to processed foods is a big culprit.

Also, many people have shifted from rural to urban areas in recent years and adopted sedentary lifestyles. Computer work while sitting, increased use of elevators rather than stairs and door-to-door purchasing and deliveries have reduced many people’s physical activity by a greater extent. It is not surprising therefore that many prefer using gadgets in their leisure time and do not invest time in sports and physical activities.

What are the possible complications of uncontrolled diabetes?

Long-term problems include retinopathy affecting eyesight, heart attack and stroke, kidney damage, nerve damage and foot problems. All these complications occur due to high sugar levels in the blood and blood vessel damage. Too much sugar in blood can also lead to more sugar in saliva. This brings bacteria, which produces acid that attacks tooth enamel and damages gums. The blood vessels in gums can also become damaged, making gums more likely to get infected.

Diabetes is an autoimmune disease. It cannot be cured. It can be managed by bringing sugar levels in the non-diabetic range. Still, this remission is not permanent, as weight gain, poor diet and non-adherence to medication can lead to poor blood sugar control.

Why is Pakistan failing to control the widespread disease and its deadly complications?

Access to healthcare services in the country, especially in rural areas, is a major concern. This may be due to the unfair allocation of funds for the healthcare sector. Most people in Pakistan earn less than $3 per day, which is insufficient to pay for insulin or oral medicines. There is a need to increase the number of healthcare centres and ensure appropriate training of the staff involved. The government must also revise its budget allocation to make treatment more affordable.

Lack of awareness remains an issue. Many people do not take the disease seriously. Many don’t wish to get screened out of fear of getting a diagnosis established as bad news. Lack of evidence-based knowledge makes them vulnerable to getting quack treatment at small health centres, which gives them temporary benefits only and is harmful in the long run.

Many medicines need dose adjustment if a person has renal failure. Also, oral hypoglycemics and insulin prescribed for diabetes control may need a careful prescription, keeping in view a person’s coexisting health condition and the adverse effects of medicines. Hence, one must consult a family physician or a diabetologist for timely treatment.

Can diabetes mellitus be cured?

Diabetes is an autoimmune disease. It cannot be cured.

It can be managed by bringing sugar levels in the non-diabetic range. Still, this remission is not permanent, as weight gain, poor diet and non-adherence to medication can again lead to poor blood sugar control.

What can be done to help manage diabetes?

Education plays a key role. It is important to spread awareness in the community regarding the disease process, its complications and solutions. World Diabetes Day, observed on November 14, and forums such as the Pakistan Diabetes Leadership Forum are examples. TV and social media play an important role in helping healthcare professionals reach the masses. Talks and programmes in schools and teaching institutes can also spread awareness about primary prevention – weight reduction, healthy diet and screening tests.

We have limited opportunities for sports and exercise as per community needs. The authorities must address this need. Such interventions may not bring about immediate changes, but will help us combat the disease over the years to come.

What is pre-diabetes, and how can diabetes be prevented?

Borderline sugar or pre-diabetes is a condition where the body struggles to push blood sugar into body cells. Hence, the blood sugars are raised but not to the point of no return. This condition can be managed with lifestyle modification and oral medicines if needed. Age above 40 years and a family history of diabetes and obesity are important risk factors. Regular exercise and dietary modification are crucial in successfully managing this condition.

The writer is a family physician