On the eve of World Diabetes Day, to be observed today, experts warned that an undisciplined lifestyle and changes in dietary habits were leading to an alarming increase in the number of diabetes patients in Bangladesh.
Observances to be held today, November 14, will focus on the theme of “Healthy Living and Diabetes for 2014-2016,” and will include a rally, discussion groups and other events.
“Diabetes is becoming an epidemic here. Developing countries like Bangladesh are especially vulnerable because of rapid changes in food habits and lifestyle, with the youth especially vulnerable to the disease,” Professor AK Azad Khan, president of the Bangladesh Diabetic Association (BADAS), told the Dhaka Tribune.
Experts said they were deeply concerned with the increasing rate at which people in Bangladesh were developing the illness, in light of an International Diabetes Federation projection on the future diabetes status of the country. They said the country lacks sufficient means to bring diabetes under control.
Dr Tanjina Hossain, endocrinologist and diabetologist at BIRDEM hospital in Dhaka said: “The International Diabetes Federation (IDF) projected that 13% of the total population would be diabetic by 2030. The figure is alarming and we are neither ready nor able to fight against it at the moment.”
The Bangladesh Bureau of Statistics (BBS) estimates the country’s total population at 157,432,941. BADAS says there are 6 million diabetics in the country with around180,000 new patients joining their ranks every year.
The IDF believes a further 2 million diabetic patients are undiagnosed and unidentified, Tanjina said.
According to the World Health Organisation (WHO), about 347 million people worldwide have diabetes. The disease is predicted to become the 7th leading cause of death in the world by 2030.
In its Diabetes Atlas Sixth Edition, 2013 the IDF estimated that 592 million people would be living with diabetes in 2035.
The WHO said diabetes was the direct cause of 1.5 million deaths in 2012.
It said 80% of diabetes deaths occur in low and middle-income countries, adding that diabetes is a leading cause of blindness, amputation and kidney failure.
Cardiovascular disease is responsible for between 50% and 80% of deaths in people with diabetes.
Types and causes of diabetes
About 90% of patients in Bangladesh live with Type 2 diabetes, while the rest have Type 1 and gestational diabetes, said Tanjina.
Type 1 diabetes, previously known as insulin-dependent, juvenile or childhood-onset diabetes, is characterised by deficient insulin production and requires daily administration of insulin. The cause of Type 1 diabetes is unknown and is not preventable with the current state of medical knowledge, according to the WHO.
Type 2 diabetes, formerly called non-insulin-dependent or adult-onset diabetes, results from the body’s ineffective use of insulin. Type 2 diabetics comprise 90% of people with diabetes around the world, largely the result of excess body weight and physical inactivity.
“In western countries, the trend is that people become diabetic patients in their later years, but in our country, many young people are becoming diabetics,” Tanjina said.
She said: “People, especially younger, urban people, aged between 30 and 40 years, who exercise little and do not make healthy food choices are vulnerable to Type 2 diabetes.”
“People who are over-weight and lead stressful lives are also vulnerable to the disease,” she added.
“Mental depression, believed to be suffered by a large number of diabetics, remains undiagnosed. Complications of the disease are as much as four times greater among depressed patients than those who are not depressed,” Professor Norman Sartorius, president of the Association for the Improvement of Mental Health Programmes and former director of the WHO Division of Mental Health, told the Dhaka Tribune.
A form of the disease that affects women who are pregnant is gestational diabetes. It is characterised by hyperglycaemia with blood glucose values above normal but below diagnostic diabetic levels, according to the WHO.
Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They are also at increased risk of developing Type 2 diabetes in the future.
Tanjina told the Dhaka Tribune: “The number of patients with gestational diabetes has increased alarmingly rapidly… Although 70% of gestational diabetics return to normal blood glucose levels after giving birth, they remain at risk for full-blown Type 2 diabetes,” she added.
Challenges and Prevention
Developing countries like Bangladesh, undergoing rapid changes in diet, lifestyle and food quality, are at high risk for an upsurge in diabetes.
There is no cure for diabetes, but it can be managed with insulin, medicine and lifestyle changes, she said.
“Urbanisation is not a problem per se, but becomes a problem when people do not find the time or space for regular physical exercise,” said Professor Azad Khan said.
Experts say the country lacks sufficient measures to fight against diabetes because there is a lack of high quality hospitals, physicians, logistic support and public awareness.
“Without a big change, we will not be able handle the growing numbers of diabetes patients, including those with cardiovascular, kidney and eye complications,” said Tanjina.
“Insulin is life for Type 1 diabetes patients. Providing insulin to Type 1 diabetics is a responsibility of the government, akin to preserving the patients’ right to life,” Azad told the Dhaka Tribune.
According to BADAS, BIRDEM buys Tk60 crore worth of insulin annually, some of which is provided for free or at subsidised rates to low-income patients.