Injecting hope: Novo Nordisk is the world’s biggest maker of insulin
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Which country has the most diabetics? The US seems the obvious candidate given its high rate of obesity – the main cause of the disease.

In fact, the answer is China, with 96.3m, according to the latest estimates from the International Diabetes Federation (IDF) published on Friday. Next up is India’s 66.8m, followed by the US with 25.8m.

Of course, these numbers are in large part simply a function of size. But they give the lie to an oft-repeated myth that diabetes is a mainly western phenomenon. More than three-quarters of the 387m diabetics worldwide live in low and middle income countries, according to the IDF’s 2014 Diabetes Atlas.

This proportion will only rise as the developing world increasingly adopts the junk food culture and more sedentary lifestyles that have fuelled the diabetes epidemic in the US and Europe.

Lars Sorensen, chief executive of Novo Nordisk, the world’s biggest maker of insulin for diabetics, says one of the chief culprits is the global trend towards urbanisation.

“When people move to cities . . . we see a tremendous rise in diabetes because of long commutes, access to junk food, stressful lives [and] little possibility for exercise . . . So it’s a huge problem for emerging markets.”

Between now and 2035, China is forecast by the IDF to see its number of diabetics rise by almost half to 142.6m, while India’s will climb by nearly two-thirds to 109m. But the biggest increase is expected in Africa, where cases are projected to rise by 92 per cent to 41.5m.

For developing world governments, this threatens to impose a heavy burden on still nascent public health systems. If left untreated, as is still often the case in many countries, diabetes causes damage to the heart, blood vessels, eyes, kidneys and nerves. Strokes, blindness, amputations and kidney failure are among the potential consequences of a disease that robs the body of its ability to control blood sugar.

Whether through the cost of treating these complications or by widening access to the medicines that can prevent them, the economic burden will be great. At an estimated $612bn this year, spending on diabetes-related treatments already accounts for 11 per cent of total global healthcare costs, the IDF says. Yet, more than 80 per cent of this money is used to treat 17 per cent of diabetes sufferers – those in the richest countries.


The number of people in China suffering from diabetes

A study published last month by the US Centers for Disease Control and Prevention suggested that, after more than doubling between 1990 and 2008, the growth of diabetes in the US may be starting to slow. This could signal that rising public awareness of the health risks from obesity and high sugar intake is starting to change behaviour. The rate of obesity in the US has plateaued at about a third of adults for a decade.

But even if lifestyles do become healthier – still a very big if – the incidence of diabetes will keep rising in the US and Europe because people are living longer and old age is itself a risk factor. The IDF projects a rise of about 30 per cent in both regions between now and 2035. Globally, the number of diabetics is forecast to rise by just over half during that period to 591.9m.

Petra Wilson, IDF chief executive, wants the G20 group of leading economies to help craft a co-ordinated global response. “It is not just a problem for health ministers,” she says. “It’s for finance ministers too. If we’re going to meet this challenge it will take a comprehensive effort across all areas of government and policy.”

Many health advocates believe public education is not enough. They point to Mexico, which last year introduced a “fat tax” on fast food and sugary drinks. Berkeley this month became the first US community to impose a 1-cent-an-ounce levy on soft drinks.


The number of people in India suffering from diabetes

High sugar consumption has been strongly linked with type 2 diabetes – the largely preventable form of the disease which occurs when the pancreas does not produce enough insulin or the body has stopped responding to it. This accounts for 90 per cent of global cases, with the rest involving type 1, which develops most often among young people and causes the destruction of insulin-producing cells in the pancreas.

Novo Nordisk and rival drugmakers such as Sanofi and Eli Lilly are developing more advanced treatments, including once-weekly injections and oral insulins, while medical device makers are working on new high-tech glucose monitoring devices and insulin pumps. All these could improve the lives of patients and increase compliance with treatment regimes.

David Cavan, IDF policy director, says the top priority must be prevention. “Science has come a long way in developing treatments to control the disease. Where we haven’t moved as far forward is in changing lifestyles and getting the political and public health communities to take this challenge seriously enough.”

Drug companies are often accused of riding the epidemic rather than trying to stop it. But the industry is increasingly recognising it has an interest in helping societies keep the cost of diabetes sustainable. Novo Nordisk, for example, has launched a partnership with Mexico City’s government to develop policies to combat diabetes and is extending the scheme to other big cities around the world.

Mads Krogsgaard Thomsen, chief science officer at Novo Nordisk, says talks with Chinese leaders have reassured him that the problem is being taken seriously. But he worries whether US and European governments are capable of a sufficiently long-term approach.

“Politicians are rarely thinking about how they can save money 20 years from now by reducing kidney failure. They are thinking about what money they have to spend on schools next year. This is a very big dilemma that policy makers need to tackle.”

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