Diabetes epidemic in Europe
About 60 million people in the WHO European Region have diabetes: about 10.3% of men and 9.6% of women aged 25 years and over. Prevalence is increasing among all age groups in the Region, mostly owing to increases in lifestyle-related risk factors.
Lifestyle choices are putting more people at risk of developing type 2 diabetes. Studies suggest that potentially modifiable risk factors – including overweight and obesity, an unhealthy diet and physical inactivity, as well as socioeconomic disadvantage – account for 80% of the increase in cases. The remaining 20% arises from non-modifiable risk factors, such as an ageing population and longer survival.
“The only sure way to control the diabetes epidemic is to stop people getting diabetes,” said Zsuzsanna Jakab, WHO Regional Director for Europe.
World Diabetes Day 2011, on 14 November 2011, focuses on education and prevention.
Diabetes is seen as a continuum, affecting people ranging from those who are healthy through those with overweight and impaired glucose metabolism, to those with diabetes who may or may not be diagnosed and suffer from complications. In general, preventing type 2 diabetes means moving people to the healthy group (from the right to the left, as shown by blue arrows in the figure). Emphasis must be given to reducing the risk of progression to type 2 in people without diabetes, and to providing health care interventions to people with diabetes that focus on improving glucose control and reducing complications.
Evidence indicates that prevention can work. Most of it comes from studies on high-risk groups: overweight people with some disturbance of glucose metabolism but no diabetes yet. A study in Finland (1), for example, found that people at high risk of diabetes, who were given a behavioural intervention to improve diet and physical activity, reduced their risk by 58% over 6 years, when compared to a control group.
Because the modifiable risk factors for diabetes (see figure) are closely connected to those for other noncommunicable diseases, diabetes prevention must be integrated into population approaches to prevent these diseases as a group.
Risk factors for diabetes
The European Region already has notable experience in addressing these risk factors: for example, using communication and other approaches to change behaviour, regulating the marketing of unhealthy goods, promoting healthier diets through reformulating food products and planning urban environments to facilitate opportunities to use active modes of transport, such as cycling and walking.
In September 2011, Member States in the European Region endorsed the Action Plan for Implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016, which includes a number of concrete, evidence-based interventions and is in line with countries’ existing commitments. These interventions include:
- promoting healthy consumption via fiscal and marketing policies
- assessing and managing cardio-metabolic risk
- promoting active mobility
- promoting health in schools and workplaces.
The Action Plan calls for countries to have comprehensive prevention strategies that balance activities to reduce risk factors in the population as a whole with those aimed at high-risk individuals.
Costs of inaction
Beyond the human cost of diabetes, treating it and its related conditions is expensive, and the broader economic impact is considerable.
Diabetes places an enormous burden on people with the disease and their families, particularly in poorer countries where people must primarily pay for medical care out of their own pockets. The disease also leads to losses in productivity and economic growth, and causes costs associated with disability and premature death.
According to the International Diabetes Federation, health expenditure for diabetes was estimated at US$ 105.5 billion in the European Region in 2010: the equivalent of 10% of the total. By 2030, this expenditure is expected to reach US$ 124.6 billion.
Diabetes in brief
Diabetes is a chronic metabolic disease, characterized by high levels of glucose in the blood. Most people with the disease have type 2 diabetes (accounting for 90% of cases), a condition caused by the body’s ineffective use of insulin. It is largely preventable through healthy diet and physical activity.
Type 1 diabetes occurs when the pancreas stops producing the hormone insulin; it requires daily insulin administration and often starts at a young age.
Gestational diabetes is associated with pregnancy. It needs careful control to help ensure a safe outcome for mother and child.
If diabetes is not managed correctly, patients are likely to become progressively more ill and debilitated. Over time, it can damage the heart, blood vessels, kidneys, eyes and nerves. A combination of physical activity, healthy diet, modern clinical control and self-management of the condition allows a healthy and productive life.