IDF DIABETES ATLAS FOURTH EDITION The mission of the International Diabetes Federation is to promote diabetes care, prevention and a cure worldwide IDF DIABETES ATLAS | FOURTH EDITION CONTENTS | 3 CONTENTS Acknowledgements 5 Foreword 7 Introduction 9 UN Resolution 61/225 10 Executive Summary 11 CHAPTER 1 WHAT IS DIABETES? 15 CHAPTER 2 THE GLOBAL BURDEN 21 2.1 Epidemiology and Morbidity 22 2.1.1 Diabetes and Impaired Glucose Tolerance 22 2.1.2 Diabetes in the Young: a Global Perspective 30 2.2 Diabetes and Depression 32 2.3 Morbidity and Mortality 34 2.4 The Economic Impacts of Diabetes 36 CHAPTER 3 REGIONAL OVERVIEW 39 3.1 Africa 40 3.2 Europe 42 3.3 Middle East and North Africa 44 3.4 North America and Caribbean 46 3.5 South and Central America 48 3.6 South-East Asia 50 3.7 Western Pacifi c 52 CHAPTER 4 THE URGENT NEED: PREVENTION AND MANAGEMENT 55 4.1 The Prevention of Type 2 Diabetes 56 4.2 The Challenges of Type 2 Diabetes 58 4.3 Diabetes Education 60 CHAPTER 5 TAKING ACTION: DIABETES POLICY AND HEALTHCARE RESPONSE 63 5.1 National Diabetes Programmes 64 5.2 Beyond Access to Insulin 66 5.3 Global Monitoring of Quality of Diabetes Care 68 CHAPTER 6 FROM VISION TO ACTION 71 6.1 The Next Health Tsunami: Non-communicable Diseases 72 6.2 Winning the Battle against Diabetes 74 CHAPTER 7 RESOURCES FOR ACTION 77 7.1 International Diabetes Federation 77 7.2 International Diabetes Federation Position Statements 78 7.3 Useful Resources 79 APPENDIX 81 Appendix 1: Country Summary Table: Estimates for 2010 82 Abbreviations and Acronyms 96 Glossary 97 References 98 Index 100 4 | IDF DIABETES ATLAS | FOURTH EDITION Online version of IDF Diabetes Atlas: www.eatlas.idf.org © International Diabetes Federation, 2009 No part of this publication may be reproduced, translated, or transmitted in any form or by any means without the prior written permission of the International Diabetes Federation. First published, 2000 Second edition, 2003 Third edition, 2006 Fourth edition, 2009 Permission has been obtained from the United Nations, Population Division to use data from the World Population Prospects: The 2006 Revision. ISBN-13: 978-2-930229-71-3 Design and layout: De Visu Digital Document Design www.devisu.com IDF DIABETES ATLAS | FOURTH EDITION ACKNOWLEDGEMENTS | 5 ACKNOWLEDGEMENTS DIABETES ATLAS, FOURTH EDITION COMMITTEE Nigel Unwin (co-chair), Delice Gan (co-chair), Jean Claude Mbanya, Ambady Ramachandran, Gojka Roglic, Jonathan Shaw, Gyula Soltèsz, David Whiting, Janice Zgibor, Ping Zhang, Paul Zimmet EDITORIAL TEAM Nigel Unwin, David Whiting, Delice Gan, Olivier Jacqmain, Grégory Ghyoot CONTRIBUTORS The International Diabetes Federation (IDF) would like to thank the following core contributors: Ala Alwan, Katrien Benhalima, David Beran, Alexandra Buckley, Jonathan Brown, Ruth Colagiuri, Gisela Dahlquist, Leonard Egede, Charles Ellis, Simon Griffi n, Ann Keeling, Chantal Mathieu, Jean Claude Mbanya, Marg McGill, Helen McGuire, Gregory Nichols, Chris Patterson, Gretchen Piatt, Gojka Roglic, Jonathan Shaw, Robyn Short, Richard Sicree, Martin Silink, Rebecca Simmons, Gyula Soltész, Dorte Vistisen, Donna Wolf, John Yudkin, Janice Zgibor, Ping Zhang, Xinzhi Zhang, Paul Zimmet IDF would also like to thank the following for their contribution: Tania Acosta, Noël C Barengo, Rafael Gabriel, Fatema Jawad, Timo Saaristo, Frank Snoek, Jaakko Tuomilehto, Harrison Wanjiru CORPORATE SPONSORS IDF would like to express its thanks to the following sponsors for their generous support of the fourth edition: Novo Nordisk A/S Merck and Co, Inc Sanofi -aventis Groupe Novartis Diabetes is a chronic, debilitating and costly disease associated with severe complications, which poses severe risks for the entire world. IDF DIABETES ATLAS | FOURTH EDITION FOREWORD | 7 FOREWORD The International Diabetes Federation is proud to they hamper the people and the economies of the release the fourth edition of the IDF Diabetes Atlas at poorest populations, even more than infectious the 20th World Diabetes Congress in October 2009 diseases. This represents a public health emer- in Montreal. The IDF Diabetes Atlas aims to gency in slow motion.” provide healthcare professionals, scientists, The World Economic Forum 2009 Global Risks health economists, policy makers, national Landscape assessment report identifi ed chronic and international governmental agencies with diseases as one of the most signifi cant risks facing evidence-based information and projections on the global economies, exceeded only by the risks the current and future magnitude of the diabetes posed by sudden oil/gas price rises, retrenchment epidemic. from globalization, asset price collapse and a Testament to the acceptance of the previous slowing of the Chinese economy. edition of the IDF Diabetes Atlas (3rd edition, 2006) Yet, despite these statements, the International has been the use of its data and projections in Diabetes Federation recognizes that the global publications from the World Health Organization, community still has not fully appreciated The World Bank, Organisation for Economic the urgent need to increase funding for non- Co-operation and Development and the World communicable diseases (NCDs), to make essential Economic Forum. NCD medicines available for all and to include It is interesting to refl ect that in the fi rst edition the treatment of diabetes and other NCDs into of the IDF Diabetes Atlas, released in 2000, strength ened primary healthcare systems. the estimated global diabetes prevalence was The evidence for the need to act will soon be 151 million. In this newest edition, the estimated overwhelming and this edition of the IDF Diabetes diabetes prevalence for 2010 has risen to Atlas has more detailed data on diabetes, co- 285 million, representing 6.6% of the world’s morbidities and costs than ever. adult population, with a prediction that by 2030 On behalf of the ‘diabetes world’, the International the number of people with diabetes will have risen Diabetes Federation expresses its gratitude to all to 438 million. Far from being a disease of higher who contributed so generously with their time and income nations, diabetes is very much a disease talents to this edition and to the sponsors for their associated with poverty, with the major burden fi nancial support. It represents an enormous body borne by low- and middle-income countries and of work from a very large number of dedicated disproportionately affecting lower socio-economic experts and staff. It is a state-of-the-art document groups, the disadvantaged and the minorities in summarizing the best available evidence-based richer countries. information on diabetes from around the world The potential impact of diabetes as a development and presents it in a more concise fashion than in issue was recognized by the United Nations in previous editions. It is complemented by a CD-ROM 2006 in Resolution 61/225 when it stated that as well as an online interactive web-based version “diabetes is a chronic, debilitating and costly which will allow readers to download graphs, data disease associated with severe complications, tables and background papers. which poses severe risks for families, Member States and the entire world and serious challenges to the achievement of internationally agreed development goals including the Millennium Development Goals”. Martin Silink In the words of Mr Ban Ki-Moon, UN Secretary- President General, “Cancer, diabetes, heart diseases are International Diabetes Federation no longer the diseases of the wealthy. Today, 2006—2009 We cannot afford to remain a bystander. It is time to give diabetes and other non-communicable diseases the attention they deserve. IDF DIABETES ATLAS | FOURTH EDITION INTRODUCTION | 9 INTRODUCTION Today, diabetes and other noncommunicable sectoral research needed to strengthen the diseases (NCDs) that share the same risk factors evidence base for prevention. represent a leading threat to health and human Once people develop diabetes, health services development. An estimated 8 to 14 million in many developing countries are unable to people die prematurely every year in developing provide effective care to control it and prevent its countries due to preventable NCDs — mainly complications and premature death. Available cardiovascular diseases, diabetes, cancers, and data indicate that a substantial proportion of chronic respiratory diseases. These people are household income among poor populations is dying too young as a result of increased exposure spent on healthcare for a family member affected to the common risk factors for NCDs: unhealthy by diabetes. Integrating diabetes care into primary diets, physical inactivity, tobacco use and the healthcare and ensuring universal coverage for harmful use of alcohol. basic health interventions should therefore be Unless addressed, the mortality and disease given top priority. burden from diabetes and other NCDs will Despite the enormity of the diabetes problem, continue to increase. WHO projects that globally, requests from developing countries for technical deaths caused by these health problems will assistance to prevent it remain largely unanswered increase by 17% over the next decade, with the by the international community mainly because greatest increase in low- and middle-income diabetes and other NCDs are beyond those countries, mainly in the African (27%) and Eastern targeted by the Millennium Development Goals Mediterranean (25%) regions. An estimated 80% (MDGs). of mortality from NCDs occurs in developing countries. Similarly, and as the IDF Diabetes Atlas We cannot afford to remain a bystander. It is time illustrates, the highest rates of diabetes occur in to give diabetes and other NCDs the attention economically developing populations. they deserve. The Ministerial Declaration adopted at the 2009 session of the High-level Segment of We have the right vision and knowledge to address the United Nations Economic and Social Council diabetes. Although cost-effective strategies exist, recognized the need to address this important high-level commitment and concrete action are health problem. It is hoped that the Declaration will still sorely needed at the global and national level.