Diabetes is a chronic disease, which occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. This leads to an increased concentration of glucose in the blood (hyperglycaemia).

Type 1 diabetes (previously known as insulin-dependent or childhood-onset diabetes) is characterized by a lack of insulin production.

Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes) is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity.

Gestational diabetes is hyperglycaemia that is first recognized during pregnancy.

Key facts

·         More than 220 million people worldwide have diabetes.

·         In 2004, an estimated 3.4 million people died from consequences of high blood sugar.

·         More than 80% of diabetes deaths occur in low- and middle-income countries.

·         WHO projects that diabetes deaths will double between 2005 and 2030.

·         Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes.

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What is diabetes?

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

Type 1 diabetes

Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.

Type 2 diabetes

Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity.

Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.

Until recently, this type of diabetes was seen only in adults but it is now also occurring in children.

Gestational diabetes

Gestational diabetes is hyperglycaemia with onset or first recognition during pregnancy.

Symptoms of gestational diabetes are similar to Type 2 diabetes. Gestational diabetes is most often diagnosed through prenatal screening, rather than reported symptoms.

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.

What are common consequences of diabetes?

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

·         Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke).

·         Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation.

·         Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment.

·         Diabetes is among the leading causes of kidney failure. 10-20% of people with diabetes die of kidney failure.

·         Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands.

·         The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

What is the economic impact of diabetes?

Diabetes and its complications have a significant economic impact on individuals, families, health systems and countries. For example, WHO estimates that in the period 2006-2015, China will lose $558 billion in foregone national income due to heart disease, stroke and diabetes alone.

How can the burden of diabetes be reduced?

Prevention

Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:

·         achieve and maintain healthy body weight;

·         be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;

·         eat a healthy diet of between three and five servings of fruit and vegetables a day and reduce sugar and saturated fats intake;

·         avoid tobacco use – smoking increases the risk of cardiovascular diseases.

Diagnosis and treatment

Early diagnosis can be accomplished through relatively inexpensive blood testing.

Treatment of diabetes involves lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.

Interventions that are both cost saving and feasible in developing countries include:

·         moderate blood glucose control. People with type 1 diabetes require insulin; people with type 2 diabetes can be treated with oral medication, but may also require insulin;

·         blood pressure control;

·         foot care.

Other cost saving interventions include:

·         screening for retinopathy (which causes blindness);

·         blood lipid control (to regulate cholesterol levels);

·         screening for early signs of diabetes-related kidney disease.

These measures should be supported by a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use.

WHO activities to prevent and control diabetes

WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low and middle-income countries. To this end, WHO:

·         provides scientific guidelines for diabetes prevention;

·         develops norms and standards for diabetes care;

·         builds awareness on the global epidemic of diabetes; including partnership with the International Diabetes Federation in the celebration of World Diabetes Day (14 November);

·         conducts surveillance of diabetes and its risk factors.

The WHO Global strategy on diet, physical activity and health complements WHO's diabetes work by focusing on population-wide approaches to promote healthy diet and regular physical activity, thereby reducing the growing global problem of overweight and obesity.

What are the risks of diabetes in children?

Online Q&A

Q: What are the risks of diabetes in children?

A: The frequency of diabetes is rising around the world, and studies are showing children are at increasing risk of developing the disease. More than 180 million people worldwide have the illness, a number likely to more than double by 2030 without intervention, according to estimates released in 2004 .* The reasons for the growing threat are not fully understood. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves - causing chronic problems and early death.

Type 1 diabetes (sometimes called insulin-dependent or childhood-onset diabetes) occurs when the pancreas does not produce enough insulin, a hormone that regulates blood sugar. The cause is not known, but it is thought to be the result of a combination of genetic and environmental factors.

Many countries are documenting higher numbers of newly diagnosed cases of type 1 diabetes, particularly in younger children. Interestingly, some disease patterns among children resemble infectious disease epidemics. Currently, there is no known way to prevent type 1 diabetes.

Type 2 diabetes (sometimes called non-insulin-dependent or adult-onset diabetes) happens when the body cannot effectively use the insulin it produces. Often preventable, it can result from excess body weight and physical inactivity, and sometimes, a genetic predisposition.

Recently, type 2 diabetes has increasingly been reported in children and adolescents, so much so that in some parts of the world type 2 diabetes has become the main type of diabetes in children. The global rise of childhood obesity and physical inactivity is widely speculated to play a crucial role. Healthy eating and lifestyle habits are a strong defence against the disease.