KARACHI, Feb 27: The total cost of diabetes care worldwide came to around US$153 to 286 billion in 2003 which as feared if doubled by 2025 would consume 7.5 per cent to 13.5 per cent of the total world’s health budget, treating Diabetes Mellitus only.
The statistics were presented by Prof Rhys Williams while discussing “How much does diabetes cost” at the second day of the ongoing International Diabetes Conference “Decade of Diabetes Care: In low resource and under-served communities” on Monday.
Addressing the event jointly organized by Baqai Institute of Diabetology and Endocrinology and the International Diabetes Federation, Prof Rhys Williams said that an effective strategy was required to curtail the huge expenditure as well as public life. The medical expert of global repute said that strategies must include improving the quality of care for existing diabetes through all possible and most effective means and preventing diabetes occurring at all or at least delay its onset.
IDF President Prof Jak Jervell said that diabetes, calculated to be the fifth leading cause of death worldwide, was attributed to rapid population growth and ageing of the people in developed world and rapid changes in life style in the developing countries - associated with modernization and urbanization followed by lack of physical activity and obesity.
Prof Allan Collins from the USA referred to emerging evidence that chronic kidney disease was one of the common complications of diabetes.
Increasing incidence of diabetes and high blood pressure was leading to chronic kidney diseases, he said mentioning that this poses a significant threat to individual and collective health as diabetes is expected to increase across the world, particularly in South Asia and Indo-Pak sub-continent.
“However, the optimistic side of the picture is that kidney disease rates in the USA are declining due to improved treatment of diabetes, blood pressure control and use of kidney protective medicines,” he told the meeting attended by over 1,000 delegates, including several from developed and developing countries.
Dr Robert J. Ligthelm from Netherlands focussed on economic costs of diabetic complications and cited the same a drain on healthcare resources and the physician’s time adding that it is not just the patient who benefits from achieving diabetes control.
“It is necessary to try and prevent occurrence of diabetic complications as far as possible,” he said referring to chances of limb amputation, blindness, renal failure and so forth.
He reiterated that timely initiation of insulin in Diabetes Type-II, in particular, was paramount to limit the risk of diabetes induced complications and improved life quality of the patients.
Dr Akhtar Hussain from Norway mentioned that global prevalence was expected to rise to 300 million, an increase of approximately 120 per cent from 1995 to 2025. He warned that the adult diabetic population in India and China would touch the figures of 46 million and 73 million respectively in the next 25 years.
He expressed his concern that while developing countries were feared to have the major bulk of diabetic population there was still major reluctance among people to initiate insulin therapy. According to him, many patients fear starting insulin therapy (psychological insulin resistance) which may deter physicians from prescribing insulin.
Dr Abdul Basit from Baqai Institute of Diabetology and Endocrinology said that diabetic foot ulcers were leading cause of amputations across the world and that 85 per cent of all lower limb amputations or a lower extremity amputation precedes diabetic foot ulcers.
“The main reason of high amputation rate is later referral,” he said mentioning that foot ulcers affect around 10 per cent to 15 per cent diabetics globally and his institute’s data reveals it to be 10.5 per cent.
Long duration of treatment and expenditure makes diabetic foot complications very costly consuming up to 40 per cent of total available resources in the developing countries, Dr Basit said.
Mentioning that the incidence of diabetes induced foot complications are quite high, Dr Karel Bakker from Netherlands said that amputation of lower extremity was usually preceded by a foot ulcer. A strategy that included prevention, education of people with diabetes and staff, multi-disciplinary treatment of foot ulcers, appropriate organization and close monitoring could reduce amputation rates by 49 to 85 per cent, he said.
Prof Andrew Boulton from the UK told the conference that foot ulcers were more commonly witnessed in developing which were also feared to experience the greatest rise in the prevalence of Diabetes Type-II in the next 20 years.
Mentioning that these ulcers are eminently preventable, he suggested that it must be remembered while treating diabetic foot ulcer that ulcer would heal if ulcer area was protected from further trauma by relieving the pressure on it through improved blood circulation and adequate infection control.
Regretting that no data is available about diabetes care in developing countries, Dr Khalid A. Rubeaan from Saudi Arabia said that this was but established that the cost of diabetes care was already very high. –-APP
