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
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