Diabetes is one of the fastest growing public health concerns worldwide. The prevalence of diabetes and lack of access to proper care increase the risk of the chronic disease turning into a public health crisis of considerable magnitude. Several factors are responsible for the increasing number of diabetic patients globally. These range from genetic disposition to lifestyle issues and the age factor.

The number of diabetics is projected to rise to 693 million by 2045 from 451 million in 2017 worldwide. It is also estimated that nearly 49.7 per cent of people living with Type-II diabetes remain undiagnosed. In patients with Type-II diabetes, the average life expectancy decreases by around ten years. Millions of people with diabetes around the world do not have access to diabetes care. Patients with the disease require constant care and support to manage their condition and avoid complications. Undiagnosed or poorly managed diabetes can result in avoidable blindness, kidney failure, heart attack, stroke and lower limb amputation, having long-standing medical and non-medical costs for patients, caregivers, families and communities.

According to World Health Organisation (WHO), diabetes is the 8th leading cause of death globally, a number that has been rising rapidly in low- and middle-income countries. In 2019, an estimated 1.5 million deaths were directly caused by the disease. Another 2.2 million deaths were attributable to high blood glucose. One in five people above 65 years of age has diabetes. And almost 232 million people with diabetes are undiagnosed.

World Diabetes Day has been observed every year on November 14, since 1991, when the International Diabetes Foundation and the World Health Organisation first decided to raise awareness about the impact of the disease as well as promote the role of the family and community in the management, care, prevention and treatment of diabetes. The theme for World Diabetes Day 2021-23 is Access to Diabetes Care. The WHO’s Global Report on Diabetes, 2016, provides an overview of the diabetes burden, interventions available to prevent and manage, and recommendations for governments, individuals, civil society and the health sector.

Key messages from the report include:

Diabetes is a chronic, progressive disease characterised by elevated levels of blood glucose.

Diabetes of all types can lead to complications in several organs and increase the overall risk of dying prematurely.

Countries must commit to halting the rise in diabetes, reducing diabetes-related premature mortality, and improving access to essential diabetes medicines and basic technologies.

Effective tools are available to prevent Type 2 diabetes and improve management to reduce the complications and premature death that can result from all types of diabetes.

The International Diabetes Federation (IDF) publication, Diabetes Atlas 9th Edition, reports that the prevalence of diabetes in Pakistan has reached 17.1 per cent. In 2019, more than 19 million adults in Pakistan were estimated to be living with diabetes, putting them at risk of life-threatening complications. Diabetes kills approximately 90,000 people annually in Pakistan. Studies reveal that Pakistan ranks 7th among the top 10 countries with the highest number of people living with diabetes.

The Diabetes Atlas (9th Edition) reports that the prevalence of diabetes in Pakistan has reached 17.1 per cent. In 2019, over 19 million adults in Pakistan were estimated to be living with diabetes, putting them at risk of life-threatening complications.

There are three main types of diabetes; Type I can develop at any age but occurs most frequently in children and adolescents. Type II diabetes is more common in adults and accounts for around 90 per cent of all diabetes cases. In such a situation, the body does not make good use of the insulin that it produces. This requires oral drugs and/or insulin to keep their blood glucose levels under control. Gestational diabetes, the third type, that causes high blood glucose levels in the body during pregnancy is associated with birth-related stress.

High blood glucose leads to damage of the nerves, mainly the peripheral nervous system leading to neuropathy. This damages blood vessels that supply the kidneys circulation leading to kidney damage. This can lead to the accumulation of wastes in the blood. High blood sugars can also damage blood vessels in the eyes, causing cataracts and glaucoma. Diabetes can cause blockage of the blood vessels, increasing the risk of stroke and heart attack. Due to damage in the nerves of peripheral nervous system, foot ulcers or gangrenes can occur. These wounds heal slowly and sometimes may lead to amputation or loss of limb. Diabetes may gradually lead to cognitive impairment or memory loss in the patients.

Symptoms vary based on the type of diabetes. The general symptoms include weight loss, increased thirst, excessive hunger, increased urination, especially at night, visual disturbances, extreme fatigue, weakness, headache, drowsiness, numbness in hands and feet, slow and improper healing of cuts or bruises and dry mouth. Some of the risk factors are age, family history and diseases of the pancreas.

People with diabetes are at increased risk of severe disease if they contract the Covid-19. For this reason, the WHO and its partners continue to respond to the pandemic threat. Like everyone, people with diabetes must continue to be encouraged to diligently observe personal protective measures such as physical distancing, hand washing and mask wearing. The WHO suggests that a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of Type 2 diabetes.

Simple lifestyle measures have been shown to prevent or delay the onset of Type II diabetes and related complications. Early diagnosis can be accomplished through relatively inexpensive testing. In addition, self-care such as proper foot hygiene, wearing appropriate footwear, seeking professional care for sore management, and regular examinations by health professionals are essential to avoid a serious threat.

Diabetes is a serious threat to global healthcare systems. The increasing number of patients in Pakistan should be a wake-up call. We must do more to prevent Type II diabetes through early diagnosis and ensure that every diabetic person has affordable and uninterrupted access to the care they need.

The writer is a   freelance journalist based in Lahore