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CLINICAL CARE: DIABETES
The global challenge
of diabetes
PROFESSOR PIERRE LEFÈBVRE (PICTURED)
PRESIDENT, THE INTERNATIONAL DIABETES FEDERATION
ANNE PIERSON
INTERNATIONAL DIABETES FEDERATION
Abstract
Diabetes is one of the main causes of death in most developed countries. Both types of diabetes are spreading
across the globe at an alarming rate, driving the condition to become one of the most challenging health problems
of the 21st Century.
Prevention is essential, and promoting a healthy lifestyle, early screening and investment in national programmes
are key to putting the scourge of diabetes on hold. The International Diabetes Federation (IDF) plays a crucial role
in the global fight against diabetes. Its objectives are to improve diagnosis, care and treatment of diabetes; promote
educational and training programmes; develop insulin availability and affordability and raise awareness of the
condition. The IDF hopes that these actions will not only save but also enhance the lives of people with diabetes.
Voir page 40 le résumé en français. En la página 41 figura un resumen en español.
Diabetes is one of the most common noncommunicable
diseases in the world and is fast
becoming a global pandemic. It is one of the main
causes of death in most developed countries and there is
substantial evidence to suggest that its incidence is
increasing in many developing countries.
The extent of the problem
The International Diabetes Federation (IDF) estimates that
currently some 194 million people worldwide, or 5.1 % in
the adult population, have diabetes and that this figure will
rise to 333 million by 2025 if nothing is done to change this
prediction.
There are two types of diabetes. Type 1 diabetes is caused
by the body’s immune system attacking the beta-cells in the
pancreas that produce insulin. The peak age of onset is
childhood and adolescence, but it can occur at any age.
Insulin is required for survival. Type 2 diabetes is a metabolic
disorder that results from the body’s inability to produce
enough insulin combined to various degrees of resistance to
the action of the hormone. Genetics, obesity, lack of
appropriate diet and insufficient physical activity appear to
play a role in the development of type 2 diabetes. It can be
controlled by diet, exercise and oral hypoglycaemic agents,
but insulin may be required for metabolic control.
Both type 1 and type 2 diabetes are spreading across the
globe. Type 1 diabetes, which accounts for less than 10% of
the total prevalence, is a particular problem in young
northern Europeans. It should be stressed however that the
incidence is increasing in many countries around the world
with an estimated overall annual rise of around 3%.
Type 2 diabetes, which accounts for about 90% of all
cases, is recording the most growth, particularly in rapidly
developing countries. The predicted increase is most striking
in India and China, but no part of the world is spared. In
addition to the alarming rise in numbers, there is also a
growing trend for the disease affecting younger age groups.
In developed countries the sharpest increases affect the over
65s, but in developing countries most new cases are
occurring in those between 44 and 65 years of age. In all
parts of the world type 2 diabetes is also emerging in
children and adolescents. It is presently recognized that type
2 diabetes in children is becoming a global public health
issue. The fact that people develop diabetes at an earlier age
will raise the threat of the onset of all the complications at
an earlier age.
The situation is further exacerbated by impaired glucose
tolerance (IGT), a state in which blood glucose levels are
higher than normal but below the level of someone with
diabetes. IGT often precedes diabetes and currently affects
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