By Karen Taylor, Director, Deloitte Centre for Health Solutions
The most recent International Diabetes Federation (IDF) data identifies diabetes as one of the fastest growing global health emergencies of the 21st century.1 In 2021, some 537 million people (approximately 10 per cent of the global population aged 20-79) were living with diabetes. This prevalence is expected to increase to 643 million by 2030 and 783 million by 2045. What's more, an estimated 240 million of those who have diabetes are currently undiagnosed.2 The IDF calculates that diabetes caused 6.7 million deaths globally in 2021. Fortunately, effective management of diabetes and regular check-ups can reduce the risk of complications, morbidity and mortality.3 This week’s blog considers the factors behind the rise in prevalence and incidence and identifies several evidence-based solutions.
Diabetes is a chronic disease in which a person's body is unable to produce or use insulin adequately. Insulin regulates the level of sugar in the blood, and the inability to regulate insulin leads to hyperglycaemia which, left untreated, can become a serious, even life-threatening condition. Health complications associated with diabetes can impact all major organs and systems resulting in eye disorders (glaucoma and cataracts), kidney disease, hypertension, diabetic ketoacidosis (DKA), chronic skin ulcers, damage to nerves and blood vessels, and peripheral neuropathies. With poor management or delayed diagnosis, diabetes can lead to a heart attack and is strongly associated with increased risk of stroke, limb amputation and premature death (some 48 per cent of deaths in 2019 occurred in patients younger than 70 years of age).4
The two main forms of diabetes are type 1 and type 2 but gestational and prediabetes are also a growing concern:
- type 1 diabetes occurs when the pancreas fails to produce insulin as it should, if at all. It can occur at any age and in people of every race, shape, and size - but it typically starts in childhood and makes up roughly five per cent of all diabetes cases.5 Compliance with insulin therapy and other treatments can help people manage their condition and live long, healthy lives6
- type 2 diabetes is a progressive disease where the body increasingly lacks the ability to process insulin properly. It accounts for 90-95 per cent of cases, typically adults, although a growing number of children are now being diagnosed. Obesity, sedentary lifestyles, unhealthy diets, smoking, age, race and family history are all risk factors. Initial treatment regimens are focused on lifestyle preventative measures such as eating healthily and taking regular exercise; and to have regular blood tests to check blood sugar levels. Failure to adhere to these measures often results in pharmacological intervention, initially in the form of tablets but, ultimately insulin injections are likely to be needed.7
Trends in incidence and prevalence
Increasing prevalence does not necessarily mean that the risk of developing diabetes is rising, but may be because people with diabetes are receiving better medical care and therefore living longer. Indeed the ‘incidence’ (rate at which new cases of diabetes occur) suggests that the rate of occurrence of type 2 diabetes may be stabilising or even falling in some high-income countries. However, in a growing number of developing countries the incidence rate has increased sharply (the Middle East and North Africa has some of the steepest rises in incidence levels).8
There are many socio-economic disparities in the care of diabetes that need to be addressed within and between countries and concerns that geopolitical instability will exacerbate disparities in access, diagnosis, and treatments. Concerns over both rising incidence and prevalence in developing countries have galvanised international bodies to act. In 2013, the World Health Organisation (WHO) published the Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) 2013-2020 aimed at curbing the rise in obesity and reducing cardiovascular diseases, cancer, diabetes and chronic respiratory diseases.9 However, since then, the continued increase in prevalence and growing incidence in many developing countries, is a clear indication that not enough has been done to tackle the magnitude of the problem.10
Consequently, in April 2021, the WHO launched the Global Diabetes Compact, a global initiative aimed at accelerating action to deliver sustained improvements in diabetes prevention and care, to enable access to equitable, comprehensive, affordable and quality treatment and care.11 The World Health Assembly subsequently agreed a ‘Resolution’ in May 2021, urging Member States to raise the priority given to the prevention, diagnosis and control of diabetes. Its focus is on increasing access to insulin; promoting harmonisation of regulatory requirements for insulin and other diabetes treatments and developing a web-based tool to share transparent information on the markets for diabetes products.12
What can be done to reverse the trend?
There is a large body of evidence showing that diabetes can be prevented or delayed, and its complications significantly reduced. In many high-income countries, there has been notable success in some prevention strategies, including sugar taxes, screening and introduction of HbA1c for diabetic diagnosis. However, there remains a lack of equity in access to such programmes.13
There is also a need to promote public health awareness in primary care on screening and managing diabetes and associated metabolic comorbidities. Educational activities, in schools, workplaces and in the media need to highlight risk factors for diabetes such as obesity and unhealthy lifestyles and empower patients to manage diabetes and its complications. This should include the importance of compliance with prescribed treatments and how to implement preventive measures such as regular eye and foot exams and kidney function tests.
Technological solutions can help transform diabetes care
Today there are an increasing number of cost-effective digital interventions that can improve access to care. The recent availability of closed loop diabetes management systems heralds the introduction of a true “set-and-forget” era, in which people with diabetes are plugged into intelligent devices and their condition is managed for them. Several companies have developed platforms that allow users to access diabetes educational resources on demand 24/7, 365 days a year, using intelligent digital software and technology that can integrate with their blood glucose measuring devices. This approach can help patients monitor their condition and obtain advice and support wherever they are, whenever needed. Integrated, smartphone solutions can also let patients see the information they want, when they like, with physical care teams intervening as needed.14
Critical to the success of digital interventions, as discussed in our 2021 report, Digital transformation: Shaping the future of European healthcare, the availability of robust evidence backing claims that technology provides benefits to both patients and payers is essential to scale adoption. For diabetes, benefits can be readily measured such as a reduction in A1C levels, lower rates of hyperglycaemia or weight reduction. Likewise, reductions in ischemic heart disease onset, myocardial infarctions, stroke and chronic kidney disease can also be tracked.15
One challenge in technology adoption is that current reimbursement models tend to focus on interventions that can be directly attributed to value, such as medicines or healthcare appointments. This means it is challenging for digital interventions that are aimed at monitoring, education and support for example, to secure reimbursement, especially in type 2 patients where health economic benefits can be harder to prove. However, an increasing number of insurance companies are seeing the benefits of expanding their coverage and reimbursement to products such as mental-health apps and telehealth technology, improving likelihood that digital diabetes management could be next.
Despite the amazing advances in treatments and the hope provided by technology developments, diabetes is still a crippling issue for the population and healthcare systems. Its associated and induced complications cost billions worldwide, and even the best device/drug pairings still leave people with diabetes fairing worse than others. There is much that still needs to be done, especially in tackling equality of access to treatments and support. The WHO Global Action Plan and Diabetes Compact and the World Health Assembly Resolution 2030 frameworks provide levers to help change the dial and act as a catalyst for change.