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The Global Burden of Diabetes: Challenges and Advances

Andrew JM Boulton, MD, DSc, FICP, FACP, FRCP
Manchester, England, United Kingdom

As 2021 begins and the coronavirus pandemic continues to spread, we are confronted with an unprecedented public health emergency. For those caring for people with type 2 diabetes, the disease itself constitutes a second growing epidemic. Diabetes now affects just under 500 million people across the world with evidence that one in two adults with diabetes remains undiagnosed.1, 2 Case numbers vary geographically with some countries in the Middle East having an extremely high prevalence of diabetes–up to 20 or even 25%. 1,2 Indeed, a recent population-based study from Pakistan showed that the prevalence of diabetes in adults was 26.3%.2 Sadly, diabetes now contributes to more than four million deaths globally on an annual basis.2

As we know, managing the treatment of people with diabetes often involves addressing comorbidities. However, the COVID-19 pandemic has presented us with a new challenge. Although people with diabetes do not appear to be more susceptible to COVID-19 infection, there is clear evidence from multiple studies that those with diabetes who develop COVID-19 and require hospital admission do less well.3 One study from the UK showed that one third of all COVID-19 deaths in hospital occurred in people with diabetes.4 Amongst those items that contribute to poor outcome include age, poorer glycaemic control, obesity and other diabetes complications.5

As always, successful management of people with diabetes requires looking at the big clinical picture. In addition to making sure that patients with diabetes take all possible precautions to protect themselves from the coronavirus, our focus must remain on helping them to achieve glycaemic control and prevent the cardiovascular complications associated with uncontrolled disease. People with diabetes face many challenges during this pandemic and the stress itself will adversely impact glycaemic control. Regular exercise and a sensible diet together with methods to control blood sugar will lead to better outcomes should a patient develop COVID-19 infection.

In spite of the challenges we face, there is reason for optimism. Our growing understanding of the relationship between diabetes and cardiovascular disease can help guide more successful treatment as we move forward. Moreover, the number of effective treatments has expanded in recent years, while new agents continue to emerge.

We can all benefit, as well, from dialog with the international community of researchers and clinicians who are focusing on these important issues. Join us for an informative and stimulating discussion of the state of diabetes treatment at the upcoming webinar, Reaching Therapeutic Goals in Type 2 Diabetes: New Options. You can add to the conversation in the comments section below. Let us know how you are managing your patients with diabetes during these difficult times. What interventions are most successful in reaching therapeutic goals for type 2 diabetes? Are you seeing differences in patient adherence to lifestyle modification and treatment during the pandemic? Have you had the experience of treating patients with type 2 diabetes and coronavirus, and if so, how has the course of their disease progressed? 

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  1. International Diabetes Federation. IDF Diabetes Atlas, 9th ed. Brussels, Belgium: 2019. Available at: https://www.diabetesatlas.org
  2. Basit A, Fawwad A, Qureshi H, et al. Prevalence of diabetes, pre-diabetes and associated risk factors: second National Diabetes Survey of Pakistan (NDSP), 2016–2017. BMJ Open 2018;8:e020961. doi:10.1136/ bmjopen-2017-020961
  3. Selvin E, Juraschek SP. Diabetes epidemiology in the COVID-19 pandemic. Diabetes Care. 2020;43:1690-1694.
  4. Barron E, Bakhai C, Kar P, et al: Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. The Lancet: Diabetes & Endocrinology. 2020;8(10):813-822. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30272-2/fulltext
  5. Schofield J, Leelarathna L, Thabit H. COVID-19: Impact of and on diabetes. Diabetes Ther. 2020;11:1429-1435.