Diabetes in BangladeshOn the right side of India, hundreds of glistening, picturesque rivers flow into the country of Bangladesh. At the same time, these majestic waterways nourish miles of leafy greenery that grow exotic fruit. However, although the nation appears to be a serene paradise, the rate of diabetes in Bangladesh grows rapidly and currently affects more than eight million citizens.

Diabetic Association of Bangladesh (BADAS)

Fortunately, the Diabetic Association of Bangladesh or Bangladesh Diabetic Somiti (BADAS) established in 1956 assists mostly lower-income individuals with the prevention, awareness and treatment of diabetes. BADAS helps reduce the prevalence of diabetes in three main ways:

  • Educating the healthcare sector on how to better treat diabetes during the coronavirus pandemic

  • Creating a study that organizes monthly community meetings and sending out weekly text messages on how to prevent and treat diabetes

  • Hosting an annual event for World Diabetes Day that offers free screenings, education and public awareness about the disease.

DMagic

BADAS helped organize a study called DMagic in the Faridpur District in Bangladesh that ran from 2015 to 2018. The study placed villagers in one of the following groups: engaging in community meetings, receiving text messages about how to prevent and treat diabetes, or attending a standard doctor for diabetes prevention and treatment. After the study finalized in 2018, researchers discovered that villagers in the community meetings group lowered their rate of diabetes by 20.7% in comparison to those who went to a regular doctor. However, the text messages proved to not be as effective in reducing diabetes among the participants. Therefore, researchers plan to organize more community meetings about how to prevent and treat diabetes in other rural areas of Bangladesh.

Teaching the Healthcare Sector to Handle Diabetes During COVID-19

BADAS recently implemented a new model to help the healthcare sector to continue to provide quality care for diabetic patients during the coronavirus pandemic. Firstly, BADAS urged the clinics and hospitals to remain open and to continue to offer services to diabetic patients. Secondly, medical professionals needed to wear appropriate gear, sanitize often, screen all patients and look out for individuals with potential COVID-19 symptoms to prevent the transmission of the virus. Next, BADAS encouraged doctors to offer free telephone and video call consultations to their patients. Lastly, healthcare facilities needed to provide sufficient medicine and supplies for diabetic patients.

World Diabetes Day Event

BADAS hosts an annual event in the region of Dhaka on November 14 to acknowledge World Diabetes Day. At the event, medical professionals offered free screenings and educated the public about diabetes. Also, doctors hosted a question and answer session to clarify any concerns and misconceptions about the disease. Next, artists sculpted clay models of healthy and unhealthy foods in an attempt to reduce the rate of diabetes among citizens. Then, the local religious leaders came forward and offered a special prayer for the public and those dealing with diabetes in Bangladesh. Lastly, hundreds of participants walked around Dhaka and carried a banner to spread awareness about diabetes.

Diabetes threatens the lives of millions of Bangladeshi citizens, especially those living in poverty. Although the fight of eradicating diabetes in Bangladesh continues, BADAS teaches many of the most vulnerable in society how to better recognize and prevent the disease.

– Samantha Rodriguez-Silva
Photo: Flickr 

Diabetes in MicronesiaFood and celebratory meals are the cornerstones of culture in The Federated States of Micronesia (FSM). The gradual change from traditional foods like fish and taro root to imported convenience foods has caused a rise in non-communicable diseases including diabetes and high blood pressure. FSM health officials attribute the rise of diabetes-related deaths to an influx of processed food. As of 2020, 463 million people worldwide suffer from diabetes, with 90% of cases being Type 2. The FSM has the world’s highest percentage of diabetics by population in the world; a staggering 37.2 % of people have diabetes in Micronesia.

Type 2 diabetes can result in a host of life-threatening complications such as heart disease, high blood pressure and amputations. Furthermore, dialysis machines, used to support patients in advanced stages of the disease, are largely inaccessible in the FSM.

Too Much of a Good Thing?

The people of the FSM traditionally fished and farmed local crops before World War II. The remote location and minimal infrastructure called for physical work to produce food, balancing the intake of nutrients with exercise. After the war, the U.S. began to import food to improve relations with its strategically located allies in the FSM. Presently, up to 40% of imports are food items. For instance, Micronesia imports 12% of canned meat products.

Micronesians, like all people, particularly those in poverty, consider prices when buying food. The median household income was $7,336 as of 2019. At this time, most Micronesians earned a living in the agriculture, fishing and tourism industries. Today, a combo meal at a fast-food chain can range from $8 to $10, whereas a head of iceberg lettuce alone routinely tops $4 per head. Additionally, because the group of islands is remote, the cost of importing goods continues to rise.

In recent years, there has been a push to return to locally grown food. Increasing the production of domestic food will lower prices and increase the demand for healthier food. Ideally, higher demand for healthy food will decrease diabetes in Micronesia. Micronesians aim to invest in their agricultural systems and to improving their growing measures. For example, hydroponics will increase the availability of affordable produce.

Displacement and Diabetes

The effects of climate change in the FSM are becoming increasingly apparent. For example, seawater is damaging productive agricultural land at an alarming rate. Native crops like breadfruit and taro suffer from rising sea levels as saltwater leeches into their root systems, limiting crop-yields or rendering them inedible.

As climate change displaces people and increases the unemployment rate, it becomes even more challenging for Micronesians to afford basic necessities like healthy food. Unfortunately, the decrease in the supply of domestic produce also inherently increases dependence on imported food.

Additionally, many residents choose to relocate on account of rising sea levels. Otherwise, services like emergency food supplies and health care become inaccessible. Displaced people are also more likely to run into financial barriers. This obstacle leads to poor diets and ultimately overrides awareness and care of diabetes in Micronesia. Finally, diabetics often suffer complications including visual impairment and amputations, increasing the likelihood that they will fall into poverty.

Education is Prevention of Diabetes in Micronesia

Battling diabetes in Micronesia requires a multidisciplinary approach: doctors, nurses, teachers and healthcare workers must striving to educate their communities about the disease. Healthcare workers have focused their response on educating patients about the causes, symptoms and treatment of diabetes. Local health departments such as those in Kosrae provide ‘One-Stop Shops’ for vital bloodwork, wound care, vaccinations and dietary advice. The staff also works throughout the surrounding communities to educate people about obesity, tobacco and alcohol use, to provide vision and blood pressure screenings and to refer diabetics and pre-diabetics to specialty clinics for follow-up.

Educating patients about wound care and infection prevention has already lowered the incidence of amputations in some areas of the FSM. On average, a quarter of people with diabetes have some form of foot or lower leg ulceration during the course of their disease. Education and prevention are pivotal in improving the outcomes of patients who receive one lower-limb amputation. Currently, 21% of these patients need a second surgery. Thankfully many clinics and hospitals have focused on nutritional education, helping patients to improve their food choices and, in some cases, to reverse the diagnosis.

Katrina Hall
Photo: Flickr

Diabetes in Pakistan

In 2019, Pakistan ranked sixth globally for the prevalence of diabetes. The recent increase in the prevalence of diabetes in Pakistan is associated with lifestyle changes. Citizens have been adapting their diets due to the industrialization and economic development within the country.

Diabetes in Pakistan

Obesity increases the likelihood of developing diabetes. Experts at the Pakistan Diabetes Leadership Forum in 2014 cited dietary changes that include consuming more saturated fats and less fiber as a cause of increased obesity and diabetes. Physical inactivity associated with economic changes in the country also contributes to the increased pervasiveness of diabetes. These diabetic risk factors decrease both insulin sensitivity and glucose tolerance.

Estimates believe that more than 6.7 million people in Pakistan have diabetes, which equates to 7.6% of the overall population. Despite its prevalence, diagnosis and treatment of diabetes in Pakistan is still limited. Only half of the estimated cases have been formally diagnosed and half of those diagnosed receive treatment. Recognizing the need for better, more accessible treatment options, organizations are combatting diabetes in Pakistan.

Diabetic’s Institute of Pakistan

Diabetic’s Institute of Pakistan (DIP) was founded in 1996. It has become the “leading organization for diabetes management, treatment, education and counseling” in the country. DIP focuses on three main aspects of fighting diabetes: prevention, treatment and management. To date, DIP has helped more than 100,000 patients.

The facility runs a diabetes awareness program and publishes educational materials in both English and Urdu. DIP also provides counseling and consultation services. The organization focuses heavily on psychological services due to its belief in emotional strength and the importance of “hope and happiness” for successful prevention and treatment of diabetes. Mental health services include an all-day helpline and counseling services that deal with stress and anger management. More traditional counseling is also available through DIP.

World Diabetes Foundation Project WDF15-947

The World Diabetes Foundation (WDF) started Project WDF15-947 to make diabetes treatment more widely accessible, especially focused on helping low-income individuals and areas. WDF supports three treatment clinics in Islamabad and Rawalpindi through training and education initiatives.

Between 2015 and 2018, WDF trained more than 300 nurses, doctors and paramedics in proper prevention, diagnostic and treatment practices in order to better serve the needs of the communities. In the same three years, nearly 13,000 screening tests were conducted. Individuals diagnosed with diabetes were referred to diabetes specialists for proper treatment. WDF also undertook an awareness campaign that included billboards, media programs for both TV and newspapers and the distribution of educational materials about diabetes in Pakistan.

The Diabetes Centre

The Diabetes Centre (TDC) is a nonprofit organization in Islamabad. It aims to improve access to diagnostic screenings and treatment for diabetes in Pakistan by providing these services for free to low-income individuals. The organization has 12 clinics that respond to specific complications of the disease, such as kidney, cardiac and eye care facilities. Since 2014, TDC treated almost 112,000 patients, of which only around 30% had to pay for treatment.

Diabetes in Pakistan remains an issue with low awareness and limited access to diagnosis and treatment services. However, these three organizations as well as many others, are working to increase educational initiatives and make treatments more accessible to combat diabetes.

Sydney Leiter
Photo: Flickr

Healthcare in Samoa
Samoa consists of nine volcanic islands in the South Pacific with a population of about 196,000. The country’s healthcare system provides the Samoan people with access to routine medical treatment. However, the country relies on outside assistance to provide aid and education to supplement people’s knowledge regarding anything more than standard medical practices. In recent decades, healthcare in Samoa has focused primarily on combating the increase of Type 2 diabetes, but several factors have hindered these efforts.

Lifestyle and Eating Choices

After World War II, the Samoan population grew dramatically, and the Samoan people’s lifestyle and eating choices began to mimic a more Western way of life. Samoa now faces some of the highest diabetes and obesity rates in the world. The United Nations Development Program, which measures countries’ well-being based on income, education and health factors, ranked Samoa 111th out of 189 countries in its 2019 report. About 20% of the people fall below the poverty line.

Many Samoans feel the need to appear as well-off as their neighbors. Bringing processed foods to social and family gatherings conveys an image of wealth. Many Samoans choose these products over local foods like fresh fruit and fish that are healthier and more nutrient-dense. As a result, many Samoans struggle not only with obesity but also anemia because they do not receive enough iron. In a 2017 study, 16% of Samoan toddlers were overweight or obese. Being able to provide more expensive, imported foods can also denote status. As a result, more Samoans eat less-healthy, processed foods that increase their risk of developing Type 2 diabetes.

Increased Need for Education 

A 2010 study funded by the National Institute of Diabetes, Digestive and Kidney Disorders found that many Samoans do not consider diabetes a major contributor to poor health. Because diseases like obesity, diabetes and hypertension are newer to their country, many Samoans do not recognize their severity. Educational efforts related to the study helped Samoans learn about the management and prevention of these diseases. Simple flip charts with large pictures and minimal text helped illustrate basic preventative measures. Although these measures were not especially thorough, they gave the people the first steps toward being more aware of the effects of their lifestyles and having better healthcare in Samoa.

In 2018, a small group of students from the Pacific Islands attending U.S. universities joined a Yale research project to learn more about solutions to these health problems so they could bring this knowledge back to their homes. With both local and overseas efforts, Samoans are becoming more educated about these diseases. This should, in turn, result in better healthcare in Samoa.

Lack of Local Health Professionals

Healthcare in Samoa is free, and several hospitals are available for people needing services. However, the country does not have enough medical professionals. From 1997- 2010, there were only 48 doctors per 100,000 people. Many of the specialists who primarily treat diabetes do not live in the country but travel there for a limited time. Although over 21% of adults have Type 2 diabetes, there is no established endocrinologist in the country. Healthcare staff have expressed a desire for more training for themselves, as well as outreach programs for their patients.

For decades, Samoans have been asking for the placement of full-time physicians in district hospitals. Just in 2020, full-time doctors were finally assigned to all of the hospitals in Samoa. Although this is a huge improvement, the community needs to continue to focus on adapting its social and cultural practices to prevent the disease from spreading. With limited healthcare staff available, an increase in knowledge and a sharing of that knowledge is the best bet for success.

Type 2 diabetes cases will continue to increase as long as Samoans make choices that increase their risk. Until they can get more support from medical professionals, the most effective way to combat diabetes seems to rely on increased education and understanding. Without adequate medical staff and proper education about nutrition, healthcare in Samoa will likely continue to focus on obesity and the diabetes epidemic.

– Tawney Smith
Photo: Flickr


Diabetes is a disease that occurs when the pancreas is unable to produce or use insulin well, resulting in a high blood sugar level. When the body fails to make insulin at all, this results in Type 1 diabetes. With Type 2 diabetes, the body does not produce or use insulin effectively. Both types come with side effects that are detrimental to a person’s life. On the African continent, South Africa has the second largest population of people with diabetes. Here are five facts that you should know about diabetes in South Africa:

5 Facts About Diabetes in South Africa

  1. Diabetes is a leading cause of death in South Africa. With non-communicable diseases (NCDs) like diabetes on the rise globally, South Africa is no exception. In 2016, diabetes and other NCDs caused 16% of the total deaths in the country. Among the South African population, there is a major lack of awareness of the disease and access to proper healthcare. Because the prevalence of diabetes in South African adults is 12.8%, it is crucial that other countries continue to support the funding and research of diabetes in South Africa.
  2. There are many adverse side effects for those living with diabetes. Diabetics must consistently track their blood sugar levels to ensure they don’t go into a diabetic coma. Additionally, diabetics are two times likelier to experience cardiovascular problems, like heart attacks or strokes. Diabetes can cause an individual’s kidneys to stop working. In most healthcare facilities in South Africa, they lack the procedures necessary to help a diabetic undergoing kidney failure, like renal replacement therapy by dialysis or through transplant. Another symptom of diabetes is neuropathy – or nerve damage – in the feet, which can lead to infection or potential amputation. In healthcare centers in South Africa, there is little equipment available for testing nerve damage in the feet and symptoms like this can often slip under the radar. Through an increase in funding from other countries, individuals suffering from diabetes in South Africa can have access to more equipment and medication necessary for dealing with diabetes.
  3. Socioeconomic disparities and other factors contribute to the prevalence of diabetes in South Africa. In South Africa, proper healthcare is inaccessible in poorer communities. The deficiency of experienced health professionals and respectable clinics makes it hard for citizens to undergo testing or treat the disease if they have it. More than one million citizens in South Africa do not know if they are diabetic. With more accurate and accessible testing, a greater population can begin treatment for the disease. It is crucial that the government receive funding to build diagnostic centers and train medical staff.
  4. Diabetes in South Africa is preventable and treatable in many ways. The most effective way to decrease the prevalence of diabetes in South Africa is to prematurely educate citizens and encourage healthy decision making. South Africa is currently working towards this goal. One recent preventative measure taken by the South African government is the implementation of a sugar tax. By charging more for sugary drinks and foods, the government is fighting obesity and helping citizens make more conscious decisions. In July 2019, South Africa briefly launched a Diabetes Prevention Programme (DPP). The DPP aims to integrate intervention treatments into a culturally relevant context through household questionnaires and group gatherings for at-risk individuals. In the conclusion of this program, the DPP will focus on using the information they gathered to create a curriculum that can educate communities about diabetes.
  5. Many countries and organizations help by funding testing centers and medical treatment in South African cities. The International Diabetes Federation (IDF) works with several organizations in the South African region to help combat the severity of the disease through advocacy, funding and training. The three organizations that are a part of IDF are: Diabetes South Africa (DSA), Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA), and Youth with Diabetes (YWD).  DSA is a nonprofit that centers around mobilizing volunteers to demand better treatment for those with diabetes, and also focuses on educating citizens and lobbying the government for better facilities and cheaper healthcare. Further, SEMDSA researches the genetic sources and causes of diabetes. This organization also promotes high standards of treatment and encourages the widespread availability of medicine.

Ultimately, it is crucial that the issue of diabetes in South Africa is at the forefront of the political agenda. With funding and research from other sources, the South African government can begin to tackle this massive health crisis.

– Danielle Kuzel
Photo: Flickr

Diabetes is a disease that occurs when the pancreas is unable to produce or use insulin well, resulting in a high blood sugar level. When the body fails to make insulin at all, this is type 1 diabetes. With type 2 diabetes, the body does not produce or use insulin effectively. Both types of diabetes come with side effects that are detrimental to a person’s lifestyle. In the African region, South Africa has the second largest population of people with diabetes. Here are five facts that you should know about diabetes in South Africa.

5 Facts About Diabetes in South Africa

  1. Diabetes is a leading cause of death in South Africa. With non-communicable diseases (NCDs) like diabetes on the rise globally, South Africa is no exception. In 2016, diabetes and other NCDs caused 16% of the total deaths in the country. Diabetes is one of the three leading causes of death in South Africa, the other two being tuberculosis and cerebrovascular diseases. Among the South African population, there is a major lack of awareness of the disease and access to proper healthcare. Because the prevalence of diabetes in South African adults is 12.8%, it is crucial that other countries continue to support the funding and research of diabetes in South Africa.
  2. There are many ill-side effects for those living with diabetes. Diabetics must consistently track their blood sugar levels to ensure they don’t go into a diabetic coma. Additionally, diabetics are two to three times likelier to experience cardiovascular problems, like heart attacks or strokes. Diabetes can cause an individual’s kidneys to stop working. In most healthcare facilities in South Africa, they lack the procedures necessary to help a diabetic undergoing kidney failure, like renal replacement therapy by dialysis or through transplant. Another symptom of diabetes is neuropathy – or nerve damage – in the feet, which can lead to infection or potential amputation. In healthcare centers in South Africa, there is little equipment available for testing nerve damage in the feet and symptoms like this can often slip under the radar. Through an increase in funding from other countries, individuals suffering from diabetes in South Africa can have access to more equipment and medication necessary for dealing with diabetes.
  3. Socioeconomic disparities and other factors contribute to the prevalence of diabetes in South Africa. In South Africa, proper healthcare is inaccessible in poorer communities. The deficiency of experienced health professionals and respectable clinics makes it hard for citizens to undergo testing or treat the disease if they have it. More than one million citizens in South Africa do not know if they are diabetic. With more accurate and accessible testing, a greater population can begin treatment for the disease. It is crucial that the government receive funding to build diagnostic centers and train medical staff.
  4. Diabetes in South Africa is preventable and treatable in many ways. Though diabetes is irreversible, there are ways to keep symptoms at bay. Type 1 diabetes often develops in childhood and is usually impossible to eliminate. However, type 2 diabetes can go into remission with medication and changes in lifestyle. A common medication used to treat diabetes is metformin. Exercise and good eating habits are helpful treatments for diabetics. The most effective way to decrease the prevalence of diabetes in South Africa is to prematurely educate citizens and encourage healthy decision making. South Africa is currently working towards this goal.One recent preventative measure taken by the South African government is the implementation of a sugar tax. By charging more for sugary drinks and foods, the government is fighting obesity and helping citizens make more conscious decisions. In July 2019, South Africa briefly launched a Diabetes Prevention Programme (DPP). The DPP aims to integrate intervention treatments into a culturally relevant context through household questionnaires and group gatherings for at-risk individuals. In the conclusion of this program, the DPP will focus on using the information they gathered to create a curriculum that can educate communities about diabetes. To prevent rising cases of diabetes it is important that there is more pervasive awareness of the causes of diabetes. Citizens can learn how to manage obesity and understand when they should seek testing.
  5. Many countries and organizations help by funding testing centers and medical treatment in South African cities. The International Diabetes Federation (IDF) works with several organizations in the South African region to help combat the severity of the disease through advocacy, funding and training. The three organizations that are a part of IDF are Diabetes South Africa (DSA), Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) and Youth with Diabetes (YWD). DSA is one organization that does its part in educating citizens and lobbying the government for better facilities and cheaper healthcare. DSA is a nonprofit that centers around mobilizing volunteers to demand better treatment for those with diabetes.

Danielle Kuzel
Photo: Flickr

Diabetes in Developing Countries
Type 2 diabetes results from the body’s ineffective use of insulin, a hormone that the pancreas makes and allows the body to either convert glucose into energy or store it. Insulin prevents one’s blood sugar from getting too high since it effectively removes glucose from the bloodstream. Diabetes is a major cause of blindness, kidney failure, heart attacks and stroke among other conditions. While there are many risk factors for diabetes, physical inactivity and excess body weight are two of the most significant contributors to type 2 diabetes across the globe. However, there is an increasing prevalence of type 2 diabetes in developing countries where investments in health care are often inadequate.

Diabetes in Developing Countries

Globally, the number of people with diabetes increased from 108 million in 1980 to 433 million people in 2019. Estimates determine that the global prevalence of diabetes is 9.3 percent, and about one in two people with diabetes are undiagnosed. The International Diabetes Federation projects that global prevalence will increase by 25 percent in 2030 and by 51 percent in 2045 if prevention methods and treatment programs remain unchanged.

Type 2 diabetes relates to obesity and overeating. Therefore, people in the past have associated it primarily with high-income countries, but this viewpoint is changing. The prevalence of diabetes in developing countries has been rising rapidly. In 2019, 79 percent of adults with diabetes were living in middle-low income countries.

Risk Factors of Diabetes in Developing Countries

A majority of type 2 diabetes cases are in advanced nations. However, the disease is becoming a serious problem in developing countries. Diabetes prevalence in low-middle-high SDI countries is 1.48, 3.74, and 3.42 percent, respectively. SDI refers to the Sustainable Development Index as an updated version of the human development index and measures the ecological efficiency of human development. Middle SDI countries also have the highest annual rate of increase in prevalence. The prevalence of diabetes in developing countries is growing with westernization and with the urbanization of rural areas. In Pakistan, for example, a recent study found that urban areas have a prevalence rate of 28.3 percent which was just higher than the rate of 25.3 percent in rural areas.

Obesity, a main contributor to the diabetes epidemic, is increasing rapidly in developing countries. This shift also connects with the nutrition transition. The nutrition transition results from changes in agricultural systems. Specifically, there is a decrease in fruit and vegetable consumption. There is also a rise in processed foods such as refined carbohydrates, added sweeteners, edible oils and animal products.

In many Asian populations, the risk of diabetes starts at a lower BMI than for Europeans. Additionally, increased intake of meat, oils, highly saturated ghee (a type of butter used in Asian cooking) and added sugar have also marked diet shifts in Asia. Before urbanization, physical activity counteracted the effects of high fat and sugar diets. Unfortunately, physical activity has also decreased as a result of the shift from agricultural labor to working in manufacturing services.

Preventive Methods

The current trends show that type 2 diabetes in developing countries will likely significantly increase, but these outcomes are preventable through lifestyle and dietary changes. Since treatments such as drugs and insulin are costly and developing countries have limited resources, people must prioritize prevention. It is crucial to raise awareness about the effects of lifestyle shifts on obesity and type 2 diabetes globally. Low-cost innovations include training non-medical health professionals and using mobile devices to spread awareness about type 2 diabetes prevention. In addition to technology, countries should develop solutions using networks of community health workers.

Accredited social health activist (ASHA) workers are an example of this type of intervention in Asia, where 70 percent of the population lives in rural areas with very limited access to health care facilities and skilled health workers. ASHA workers are health educators in their own communities and have the ability to care for patients at home while also providing guidance regarding diet and physical activity. Telemedicine and the use of technology support this system and keep the ASHA workers in touch with medical professionals. This intervention also offers employment to people with some medical knowledge. ASHAs are able to make money by charging low fees for their services and provide for their families.

Making cities more walkable or cyclable through urban planning can increase physical activity while taking some of the prevention weight off of health systems, especially in countries with limited health resources. Making healthy food more affordable through redesigning subsidies needs to be a priority. This is because industrialization makes processed food cheaper and more accessible. These actions require political will and an understanding of the negative implications of the growing diabetes prevalence. Such actions could make a significant difference in decreasing the epidemic globally.

Maia Cullen
Photo: Pixabay