By E.J. Mundell HealthDay Reporter

Updated on June 12, 2022

FRIDAY, March 16, 2007 (HealthDay News) -- More than two-thirds of the world's estimated 246 million diabetics come from less-affluent developing nations, and more must be done to curb a disease that now rivals HIV/AIDS in terms of suffering and death around the globe.

That sobering assessment was offered by experts gathered at this week's Global Changing Diabetes Leadership Forum in New York City, which included keynote speaker former President Bill Clinton. The conference is one of the largest such gatherings ever of scientists, health-care advocates and government leaders focused on the issue.

"This truly is an epidemic," warned Dr. Martin Silink, president of the International Diabetes Federation (IDF), which represents more than 200 diabetes associations across 158 countries. "Seventy percent of the global burden of diabetes is now in developing countries, even though that seems paradoxical. People think that it should be in the developed world where there is access to fast food and lots of obesity."

But rapid lifestyle changes are affecting the health of people in China, India, South America, and elsewhere, he said. "As their economies develop, diabetes is now subverting the gains of economic development," Silink said.

The issue has gained such urgency that the United Nations' General Assembly in December passed a global resolution to encourage the prevention, treatment and care of diabetes. The U.N. has only passed one such disease-targeted resolution before, when it vowed to fight HIV/AIDS.

Some statistics from the IDF:

  • By 2025, the number of people with diabetes is expected to rise to 380 million worldwide, with 80 percent living in the developing world.
  • Each year, another 7 million people develop diabetes, while 3.8 million die of diabetes-linked causes.
  • In many countries in Asia, the Middle East and the Caribbean, diabetes already affects 15 percent to 20 percent of the adult population.
  • India now has the largest number of diabetics (almost 41 million) in the world, followed by China (nearly 40 million), the United States (19.2 million) and Russia (9.6 million).
  • Diabetes increasingly affects the young or middle-aged, with more than half of diabetics in developing countries between the ages of 40 and 59.

According to the experts, a "perfect storm" of genetics and social change is driving the spread of obesity-linked type 2 diabetes in poorer countries. Visitors to today's China quickly notice McDonald's, KFC and other fast-food outlets springing up in major cities. At the same time, the foot and bicycle are making way for the car on urban streets.

Scientists have also long understood that Asians, Hispanics and blacks are more vulnerable, genetically, to develop type 2 disease compared with those of European descent.

"They simply don't have to get as obese as a European to get diabetes," Silink explained. Among non-Europeans, even a relatively modest increase in abdominal fat -- the so-called "spare tire" -- can trigger changes that lead to insulin insensitivity and diabetes.

"The risk of diabetes in a European starts rising after a body mass index (BMI, a ratio of weight to height) of about 25 or 26," the normal threshold for overweight, Silink said. "But for a person coming from Bangladesh or India, that risk curve starts after a BMI of just 22," he said.

A person who is 5-feet, 8-inches tall and weighs 145 pounds has a BMI of 22.

Too often, expensive, pay-as-you-go health-care systems in developing countries mean diabetes isn't even detected until it reaches crisis levels, Silink added. The results -- prolonged disability, amputation, even death -- can destroy a family's income.

Urban stress is another factor driving the epidemic, as the world's poor seek employment in cities, Silink said. For reasons that remain unclear, "we know that simply moving from a rural environment to a city doubles your risk of diabetes without any change in body mass," he said. "And if you have to go to a 'mega-city' -- a population of over 10 million -- the risk probably rises fourfold."

Another expert said it's not too late to put the brakes on this developing crisis, however.

Dr. Alan Moses was the former chief medical officer of Harvard's Joslin Diabetes Center and is now associate vice president of medical affairs at pharmaceutical giant Novo Nordisk, which sponsored the conference.

"We tend to think of the costs associated with diabetes and worry that putting appropriate resources into diabetes is going to cost more," he said. "But diabetes is one of the few conditions where when you improve health, you actually reduce the cost burden on society. It should be viewed as an investment with a real return."

Certain steps taken by governments in the developed world are already helping. For example, Sen. Guy Barnett of Australia, himself a type 1 diabetic, said his government is moving to change what he labeled an "obesinogenic" environment Down Under.

Along with the United States, "we are one of the fattest countries on Earth," Barnett told reporters at a press conference held Wednesday. "But for governments everywhere, (diabetes) is a monster that is getting bigger and bigger."

With one in 10 Australian children now obese, the Australian government has mandated healthy school lunches, boosted funding for after-school physical activity programs and negotiated with fast-food giant McDonald's to make menus healthier. Former U.S. President Clinton helped broker similar deals with food companies last year to keep unhealthy sodas and snacks out of American schools.

Those and other initiatives can and should be tested in countries worldwide, Silink said. In one sense, he said, developing countries have a real edge on the West, since "they are still in the process of developing their new towns, their urban centers.

"So, in terms of town planning, societal engineering, they have a chance to engineer it for health and not for conditions that are detrimental to human health," Silink said. "It's up to the diabetes world to work with the various organizations to make this happen."

More information

Find out more about diabetes at the American Diabetes Association.

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