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Diabetes in developing countries: innovation and hope

Diabetes was the focal point of this year’s World Health Day, held earlier this month. Despite the fact that the world is overwhelmed with communicable diseases and a plethora of other health risks, the global fight against diabetes remains imperative as diabetes’ prevalence keeps rising globally and taps into already scarce resources.

An analysis from the NCD Risk Factor Collaboration showed that the number of people living with diabetes almost quadrupled between 1980 and 2014; increasing from 108 million to 422 million people worldwide. The same study found that the prevalence of diabetes has either increased or remained steady in every country, steadily growing globally within the same time period, from 4.7% to 8.5%.

It is imperative to take a closer look at low- and middle-income countries, where 80% of the people living with diabetes are found. Such countries are no longer only fighting against infectious diseases, but are facing a double burden of disease; where non-communicable diseases (NCDs), including diabetes, appear alongside communicable ones. Further, such countries also experience a double burden of malnutrition; where obesity also appears alongside undernutrition. These changes in patterns of diseases are driven by increased urbanisation, a lack of physical activity, a shift from traditional diets mostly composed of staple foods towards processed foods that often contain less fibre, and higher levels of processed sugar and of trans and saturated fat.

In Zimbabwe for example, one in four children under the age of five suffers from chronic malnutrition and a recent systematic review and meta-analysis found that the prevalence of diabetes has been significantly growing over the past three decades. The latest statistics from the Zimbabwe Diabetic Association estimates that about 1.4 million people are living with the disease; this represents more than 10% of the population. According to Dr. David Okello, the United Nations World Health Organisation Representative for Zimbabwe, barriers to the implementation of appropriate interventions arise due to the lack of appropriate data on the actual burden of non-communicable diseases. He urges the need for increased attention to diabetes and other chronic diseases, as well as for governments and other health entities to maintain their efforts in improving access to diagnostic services and treatments.

Diabetes consultation at a hospital in Bamako, Mali © Olivier Hébrard

The surge of diabetes and its complications in low- and middle-income countries adds pressure onto already deficient health systems. In 2011, diabetes-related costs in developing countries were significantly higher than the per capita GDP expenditure on health. In Cameroon for instance, the cost of diabetes care per patient per year was US$489 in 2002, accounting for approximately fifty times the per-head public health expenditure overall. Interestingly, this statistic only refers to the public health expenditure and does not include individual and social costs, such as catastrophic healthcare spending, absenteeism at work, as well as the emotional toll of the loss of loved ones. With such high associated costs, diabetes is a challenge at all levels, and hence an obstacle to sustainable economic growth.

During this year’s World Health Summit, the main theme adopted was ‘sustainable and affordable innovation in healthcare’. Médecins sans Frontières (MSF) highlighted the issue of access to insulin in a refugee camp in Kenya and gave an example of how innovation and collaboration can overcome the barriers to diabetes management. During the presentation, the experts agreed that technology can be useful to address the identified and well framed problems.

The problem identified by MSF was not access to insulin in terms of availability, but rather maintaining the viability of it. Previously, patients had to go to the healthcare facilities twice a day to get their insulin shots. This is because insulin can be unstable at high temperatures and often patients do not have access to fridge to keep it viable. In fact, throughout the refugee camp, women were not visiting the healthcare facilities to get their nightly shots because of high insecurity and danger of assaults. MSF in collaboration with the Geneva University Hospitals (HUG), decided to tackle this issue by measuring the stability of insulin at higher temperatures than recommended. They further assessed the possibility of healthcare workers providing these nightly insulin shots in the morning, rather than at night. With more stable insulin, patients could bring the shots home and inject themselves, avoiding the need to visit the healthcare facilities at night. Results from this study showed that insulin was relatively stable in the Kenyan climate, and with such encouraging results, MSF implemented this novel strategy and it has so far appeared effective.

Certainly, innovation is pushing forward what can be done in the management of diabetes in low- and middle-income countries, as well as in high-income ones. By developing and inventing devices to improve compliance and reduce invasive procedures, there is hope for the future. The collaboration between MSF and the HUG shows that partnerships are essential, supporting the need for more Public Private Partnerships, an effective instrument for sustainable development. For instance, together, Google and Novartis are developing contact lenses which will provide diabetic patients continuous measurements of the body’s glucose levels, while ‘Smart Insulin’, – which aims to release insulin according to the body’s glucose level – is under trial.

Innovations are promising for the management of diabetes, as well as its prevention. Indeed, focus on prevention strategies should absolutely not be reduced, but strengthened. The remaining question regarding innovation is: can it occur fast enough to catch up with the threats of diabetes – and for that matter other non-communicable and novel diseases – before health systems become entirely overwhelmed worldwide?

Featured image © Jill Brown

Barbara Ducry undertook her nursing qualification in Switzerland, and developed a strong interest in global health issues while working in Madagascar. She holds an MSc in Global Health and Development  from University College London (UCL). Barbara is passionate about global trade, agricultural and food policies, and their impact on the food environment, specifically on health, and food security.

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