29 July 2016

Diabetes in Developing Countries

Diabetes is one of the world’s fastest growing epidemics. Once seen as a “disease of affluence”, diabetes is becoming ever more prevalent in the developing world despite their lower obesity rates. New statistics show that four out five people diagnosed with diabetes are living in a developing country, with 60% of sufferers residing in Asia. Asia’s sudden emergence as the world’s epicenter for type 2 diabetes is predominantly due to three main factors: rapid urbanization, nutrition transition and lack of sufficient treatment.

In developed countries, obesity is the prime driver behind the type 2 diabetes epidemic. With adult overweight and obesity levels hitting a massive 68.8% in the United States, it is no surprise that they are suffering with the third highest level of type 2 diabetes in the world. However, despite their significantly lower levels of obesity, both India and China surpass USA’s diabetes levels. Studies have shown that if you live in a developing country, you are susceptible to developing type 2 diabetes at both a lower age and a lower BMI than if you were living in developed countries.

Recent research has proven that rapid urbanization of developing countries and the associated nutrition transition, are predominantly to blame for the rise of type 2 diabetes. Globalization has increased global food trade, thus introducing new and unknown foods into peoples’ diets. Where a family had been digesting course grains, they now ingest highly refined grains that contain a significantly higher glycemic index (GI) and glycemic load (GL). Furthermore, sugars and edible oils have never been more accessible nor cheaper in developing countries. Therefore, diets are quickly incorporating more sugar and fats, causing a significant nutrition transition.

With urbanization comes lifestyle change - urbanization has introduced increased industrialized foods into the diets of developing countries, while simultaneously promoting more sedentary lifestyles. Therefore, over-nutrition is occurring. With such dramatic changes in a short period of time, the increase in early onset of diabetes is partially due to under nutrition in early life, and over nutrition on later life.

One of the more significant consequences of diabetes is loss of sight. Diabetic retinopathy occurs when a diabetic’s blood sugar is too high. The blood vessels at the back of the eye become damaged, leading to the leakage of blood and fluid of which distorts vision. If left untreated, this can cause the permanent loss of vision.  In developed countries, such as the US, awareness and treatment of diabetic retinopathy is sufficient enough to prevent the risk of blindness. This, however, is not the case in developing countries. In India, eye care centres remain sparse and largely unavailable to those who need help the most. Described by A. Kumar as an “alarming epidemic”, it is believed that screenings should be mandatory at least once a year.

Nazimul Hussain MS, a vitreo-retinal consultant at the Tej Kohli Cornea Institute in Hyderabad, states that there is a “gross difference” in the accessibility of diabetic retinopathy in the rural areas of India opposed to the more urban centres primarily due to the “lack of human resources and infrastructure facilities”. At the Tej Kohli Cornea Institute, efforts are being made to ensure laser treatments and screening facilities are available to every citizen. Increasing outreach programmes to raise awareness and available treatments is just one step the Tej Kohli Cornea Institute are taking to halt the growing rate of diabetic retinopathy in developing countries.