November 14 was World Diabetes Day – an annual reminder that diabetes remains a major, global epidemic that today affects 382 million people. According to figures released today by the International Diabetes Federation (IDF), the number of people with diabetes worldwide is projected to rise to nearly 600 million by 2035. Nearly 5 million people died last year as a result of diabetes – half of them under age 60. The economic cost is also devastating: $548 billion worldwide in 2013 alone.
It’s not just the scope but also the complexity of diabetes that makes medical research and treatment so urgent and so challenging.
Just as we’ve learned that cancer is not one disease but more than 200, so we’ve come to understand diabetes is an enormously complex and heterogeneous condition that involves many genes, molecules, and organ systems. The risk and course of the disease in an individual is affected by a range of genetic and environmental factors, and it can result in a variety of complications, including blindness, nerve damage, kidney failure, heart disease, peripheral artery disease resulting in amputations, and stroke. Co-morbidities, including depression and cognitive decline, are also prevalent.
A brief overview:
Type 1 diabetes is an autoimmune disease that attacks cells in the pancreas that produce insulin, a hormone required for blood glucose to be converted into energy throughout the body. The discovery of insulin in the 1920s was a huge breakthrough – literally a life-saver – but still not a cure.
Type 2 diabetes, which comprises 95 percent of all diabetes cases, is a chronic, progressive disease. It is usually linked to obesity and is characterized by persistent high levels of glucose in the blood – typically accompanied by high blood pressure, abnormal lipid levels and other metabolic abnormalities. Left untreated, these can lead to serious, even fatal, damage to body organs and tissues.
The good news is that people at risk for type 2 diabetes can prevent the disease by avoiding weight gain with healthy nutrition and exercise. Others who develop type 2 diabetes can, with appropriate care, successfully manage it to delay or avoid serious consequences of the disease. This often requires the use of multiple medicines.
But the reality today is that the ravages of diabetes are often unimpeded by medical care. Half of the 382 million people with diabetes today don’t even know they have it. And only one in seven U.S. adults receiving treatment for diabetes is currently meeting the combined goals for blood sugar, blood pressure, and cholesterol set by the American Diabetes Association .
So diabetes awareness is critical. At the same time, medical science must search for new medicines to help people manage their diabetes and new approaches to treat complications and co-morbid conditions. That’s why pharmaceutical researchers continue to develop a variety of oral and injectable medicines, including newer types of insulin, as well as improved delivery devices – and why it’s important that these advances be available to people around the world.
This work reflects another dimension of diabetes’ complexity – its disparate impact on different nations and ethnic groups – as we strive to meet the diverse needs of diabetes patients in both developed and developing countries.
Here in the U.S., for example, diabetes is much more prevalent in some population groups. In national survey data from 2007-2009 reported by the Centers for Disease Control, the prevalence of diabetes was 7.1 percent in non-Hispanic whites, but 11.8 percent in Hispanics, and 12.6 percent in non-Hispanic blacks.
Scientists believe that genetic factors might play a role. Some hypothesize that a “thrifty gene” – which helped us store food energy in order to survive when food was scarce – may now increase risk for obesity and type 2 diabetes. Environmental and social factors could partly explain ethnic differences in diabetes.
China is an important case study. One in every four people in the world with diabetes lives in China – nearly 100 million. A recent survey estimated the prevalence of diabetes among Chinese adults to be over 11 percent. More alarming, 50 percent of adults met at least one diagnostic threshold for pre-diabetes. To help meet the large and growing need, Lilly today announced a $350 million expansion of our site in Suzhou, China, to manufacture more insulin for people with diabetes in that country.
A study reported in the Journal of the American Medical Association in September found that, with the rapid onset of changes in diet and lack of exercise driven by rapid economic development, the Chinese are developing obesity and type 2 diabetes at younger ages and at a lower body mass index than typically seen among Americans.
Recognizing that genetic and environmental factors in China and across Asia may affect individuals’ susceptibility to diabetes and how it manifests itself, in 2012 we launched the Lilly China Research and Development Center in Shanghai to focus specifically on type 2 diabetes as it is manifest in China. We’re also increasing the number of patients enrolled in clinical trials in China and investing in the clinical and scientific education of Chinese doctors, so that they will be better prepared to treat patients with Type 2 diabetes, and also ready to participate in future clinical trials.
On this World Diabetes Day, one aspect of diabetes is the same all across the globe: Wherever they live, people with diabetes face a complicated and frustrating life-long challenge to manage their disease. Helping them do just that – halting the devastation of this global epidemic – is what keeps researchers motivated as they wrestle with the complex challenge that is diabetes.
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source: Forbes Contributor John Lechleiter