- Andrea Chipman — United Kingdom
The Price of Prediabetes: A Growing Threat to Emerging Markets
The growing economic burden of diabetes globally, and its particular impact on emerging markets, has highlighted the importance of focusing on prediabetes, the stage at which type 2 diabetes is not fully established and elevated glucose levels can still be reversed.
Diabetes was the cause of nearly $1 trillion in health expenditures worldwide in 2021, according to the International Diabetes Federation’s (IDF) Diabetes Atlas tenth edition. A 2018 study by King’s College, University of London, found that the global cost of diabetes is set to reach $2.5 trillion by 2030. Even if countries meet current targets, the disease’s global economic burden will increase by 88% by the end of the decade, the researchers found.
In a recent FGH Talk organised in collaboration with Merck KGAa, speakers Vanessa Candeias, senior advisor at the Health Finance Institute (HFI) and Helen McGuire, a global program leader of the NCD programme at PATH, emphasised the threat diabetes poses to low and middle-income countries (LMICs). India alone is expected to lose $140 billion to diabetes between 2012 and 2030 and China is likely to spend some $590 billion in direct costs related to the disease if current trends continue, Candeias noted. Because these countries have limited resources and are experiencing fast-paced economic change, developing policies to combat prediabetes can help save both lives and money.
Knowing that 90% of type 2 diabetes can be prevented using different intervention, the conversation is about making sure these strategies are implemented, Candeias said.
With around 422 million people worldwide living with diabetes, the majority of whom live in LMICs, making information about healthy diets, activity and the risk factors for diabetes is essential. Partnerships are also likely to be crucial to ensuring effective strategies that mitigate the economic burden of diabetes on cash-strapped health systems and large-scale improvements in the lives of people with diabetes. Both speakers suggested a number of ways in which stakeholders might work together to further these goals, in a series of questions and answers.
Q: What specific sectors/industries should we prioritize bringing into the conversation about creating and implementing diabetes solutions?
A (VC): “For diabetes, it is crucial to make sure that individuals, families and communities have access to healthcare systems with timely, quality and affordable screening, treatment and care.
Equally important is to ensure that the healthier choices are the easiest choices available in the places where people live, work, learn and play. These need to cover different aspects of life such as healthy food intake, regular physical activity, no harmful use of alcohol, no drugs, nor tobacco consumption. Therefore, it is critical to bring into the conversation urban planning services, housing, transportation, food and beverage industries, retailers, supply chain, insurers, education systems, technology, media, community engagement tools and of course pharma, medtech, healthcare payers and providers.”
Q: If we look at the possible cross-sectoral approaches to diabetes prevention, do you have concrete recommendations for which types of partnerships would result in the greatest economic impact for emerging markets?
A (VC): “Multi-stakeholder partnerships for diabetes prevention need to address concrete community and population needs. So, a thorough needs assessment and understanding of the target population is key to success, as well as their involvement throughout the lifecycle of the partnership. The partnerships need to have clear goals, objectives and continuous evaluation systems in place.
Moreover, the backbone of effective partnerships, particularly multi-sector and multi-stakeholder partnerships, is good governance with strong leadership, secured resources and a clear sense of the common purpose and the positive impact that the joint work will deliver on individuals, families and communities living with diabetes.”
Q: In the recent FGH Talk, you mentioned the opportunity for policy change amid the changing market dynamics in emerging markets. What are some tested examples of policy that you would recommend additional countries consider adopting for improved long-term public health and economic outcomes?
A (HM): “Universal health coverage that supports screening, treatment, and care for diabetes, coupled with the use of community health workers (CHWs) and volunteers to bring screening and monitoring closer to where people live and work, are keys for ensuring diagnosis is made before the onset of costly complications. Investment in prevention and easy to access resources for people at risk for diabetes is also crucial.
Both Brazil and Mexico have made investments in primary health care strengthening, which includes diabetes management. It is interesting to note that in your recent survey, both countries reported high levels of confidence for accessing and understanding diabetes information and care. In Vietnam, people used to feel that they had to go to a physical institution to have costly screening for diabetes. The government decided to provide it in the community, with linkage to services following the screening. CHWs can target those falling away from care; it’s a combination of using healthcare workers, digital relationships and partnerships.
Countries should invest in NCD data quality and use at all levels of the system to inform planning, resource allocation, supply management, and service delivery. Countries with strong health information systems were shown to fair better overall and during times of crisis.
Making diabetes medicines and associated health products accessible at the community and primary care level versus at hospitals will make diabetes management easier and result in improved health outcomes. PATH is working with partners on a co-bundling solution in several countries to improve diabetes self-care. In a recent survey by Merck, participants in both countries reported high levels of confidence for accessing and understanding diabetes information and care.”
Q: In many instances, private sector actors like the food and beverage industry impact health outcomes substantially before policy can effectively ‘catch up’. What short-term actions can be taken to bridge the gap between these changing conditions and policy, and which actors should enact these?
A (HM): “Everyone has a role to play to expose the marketing and prevent the influx of processed foods high in sugar and fat especially those targeting younger people. We do not have to wait for policy change. Social action and behaviour change strategies can make a difference as was seen in Mexico. Follow through and continued advocacy is needed, including cross-ministerial partnerships, to accelerate policy change and support its implementation.”
Watch the complete FGH Talk below, moderated by Aimee Andag-Silva, MD, here and read her opinion piece The Sugar Crossroads: Timely diabetes intervention is key here.
The views expressed are those of the author and do not necessarily reflect the position of Re:solve Global Health.