Proceedings from the International Diabetes Conference 2016 at UK, House of Commons held on 3rd February 2016 by the All Party Parliamentary Group (APPG) for Diabetes

The meeting was very well attended with over one hundred (100) delegates from about fifteen (15) countries and all walks of life interested in the field of diabetes – politicians, clinicians, diplomats, charities and scientists to name a few. Keynote speakers were: Dr. Francisco George, Director General of Health, Portugal; Dr Pablo Kuri Morales, Minister for Health Prevention of Mexico; Hon Jane Ellison MP, Minister for Public Health of United Kingdom; Rt Hon Keith Vaz MP, Chair, APPG for Diabetes; Professor Jonathan Valabhji, National Clinical Director for Obesity and Diabetes, NHS England and His Excellency, Ambassador Nabil Ammar, Ambassador to the United Kingdom, Tunisia.

Diabetes is one of the largest global health emergencies of the 21^st century and there are currently 415 million adults estimated to currently have the condition and another 318 million with impaired glucose tolerance and hence at risk of developing the disease in the future.

Diabetes is a condition where the amount of glucose in your blood is too high because the body cannot use it properly. This is because your pancreas doesn't produce any insulin, or not enough insulin, to help glucose enter your body's cells – or the insulin that is produced does not work properly (known as insulin resistance). – Diabetes UK.

There are three main types of diabetes:

1. Type 1 diabetes: Sudden onset and not curable at present. Risk factors include: Family history of the condition, genetics, infections and other environmental influences.
2. Type 2 diabetes: The body does not produce enough insulin or that the insulin produced is not working properly and hence glucose is poorly utilised by the body. Risk factors include excess body weight, old age, physical inactivity, family history of diabetes and poor nutrition to name a few.
3. Gestational diabetes: This only appears during pregnancy and can lead to serious health risk for both mother and child. It usually develops around the third trimester (after 28 weeks) of pregnancy and disappears after the baby is born. It is associated with an increased risk of both mother and child developing diabetes later on in life.

According to the International Diabetes Federation (IDF Atlas, 7^th, edition, 2015), the estimated number of people with diabetes worldwide (20 -79 years) and per region in 2015 and 2040 are:

North America and Caribbean: 44.3 million in 2015 and 60.5 million in 2040
Europe: 59.8 million in 2015 and 71.1 million in 2040
Middle East and North Africa: 35.4 million in 2015 and 72.1 million in 2040
South and Central America: 29.6 million in 2015 and 48.8 million in 2040
Africa: 14.2 million in 2015 and 34.2 million in 2040
South East Asia: 78.3 million in 2015 and 140.2 million in 2040
Western Pacific: 153.2 million in 2015 and 214.8 million in 2040
World: 415 million in 2015 and 642 million in 2040

In 2015, one in 11 adults have diabetes and in 2040 one in 10 adults will have the condition.

In 2015, 215.2 million men has diabetes and in 2040 328.4 million will have it. 199.5 million women have the condition in 2015 and in 2040, 313.3 million will have it

Diabetes is more prevalent in urban areas than rural area with a ratio of circa 2:1 in 2015 and predicted to rise to circa 3:1 in 2040.

Type 2 diabetes explained above accounts for about 90% of all diabetes cases. However, Type 1 is increasing by around 3% a year particularly in children and without insulin therapy, the life expectancy of a child with Type 1 diabetes is very short.

In 2015 the number of children with Type 1 diabetes exceeded half a million for the first time. According to International Diabetes Federation: IDF Diabetes Atlas, 7^th edition, 2015, the top ten countries of children with type 1 diabetes (0-14) years are:

1. USA – 84.1K
2. India – 70.K
3. Brazil – 30.9K
4. China – 30.5K
5. United Kingdom – 19.8K
6. Russian Federation – 18.5K
7. Saudi Arabia – 16.1K
8. Germany – 15.8K
9. Nigeria – 14.4k
10. Mexico – 13.5K

Again from the same IDF source, 5.0 million adults died from diabetes in 2015. And from World Health Organisation (WHO) Global Health Observatory Data Repository 2013, 1.5 million adults died from HIV/AIDS, 1.5 Million adults from Tuberculosis and 0.6 million from Malaria – all in 2013. So it can be seen that diabetes kills more people than HIV/AIDS, Tuberculosis and Malaria combined.

Virtually every region of the world has seen a continuous increase in Diabetes. The heavily populated Western pacific has 153 million adults with diabetes. North America and Caribbean Region has the highest prevalence per capita with one in eight adults with the condition.

Europe has the highest number of children with Type 1 diabetes; about 140k and see an increase of circa 21.6k new cases a year.

In South East Asia Region, 24.2% of all live births are affected by Gestational diabetes.

In Middle East and North Africa 20% of adults with diabetes are undiagnosed whilst in South and Central America, the number of people with diabetes will increase by 65% by 2040.

In the Africa Region, it is challenging to estimate the total number of people with diabetes as more than three quarters of countries lack nationwide data, according to IDF. Thus the regional estimate is produced using data from just 12 countries, the other 37 countries have no data hence blurring the true picture of the prevalence of the disease from the region.

The top ten countries for number of adults with diabetes according to IDF are:

1. China – 109.6M
2. India - 69.2M
3. USA – 29.3M
4. Brazil - 14.3M
5. Russian Federation – 12.1M
6. Mexico – 11.5M
7. Indonesia – 10.0M
8. Egypt – 7.8M
9. Japan – 7.2M
10. Bangladesh – 7.1M

It is this author's view that Nigeria with a population of around 170 million people should be in the top ten but for lack of adequate data.

According to one of the keynote speakers, Dr Francisco George, Director General of Health, Portugal – Diabetes is the fastest growing health problem in Portugal with about 60k new cases diagnosed every year. This, the government has recognised and has deployed a couple of initiatives to address the problem. Initiatives like a web based tool to track glucose level between patients and clinicians, enforced by the state and funded via the national lottery. They are also addressing the issue of sugar consumption across board in the country by reducing the amount of sugar in sachets.

For Mexico, Dr Pablo Kuri Morales, Minister for Health Prevention of Mexico in his presentation pointed to obesity as a big cause for the increase in number of diabetics seen in the country with the country spending 0.4% of its GDP on diabetes treatment and management. Measures like sugar tax has been introduced to tackle the situation.

Hon Jane Ellison MP, Minister for Public Health of United Kingdom in her presentation said that about 3.2 million people are diagnosed with diabetes in the country and another 0.5 million, undiagnosed. The cost of treating diabetes and associated conditions to the UK National Health Service (NHS) is circa £10 billion pounds a year amounting to 10 percent of NHS expenditure.

For Tunisia, His Excellency, Ambassador Nabil Ammar, Ambassador to the United Kingdom, Tunisia painted the picture of diabetes in his country. According to His Excellency, Tunisia embarked on a free health program for its citizens since 1956. Birth control mechanism are in place and the country is currently recording a negative population growth. However, there is a 10.9 % prevalence in diabetes rise since 2005 rising to 15% in 2015. 50% of diabetics suffer from diabetes associated complications of blindness, kidney failure and amputation and 70% eventually die from these complications. Hence tackling diabetes is a priority for the government.

Professor Jonathan Valabhji, National Clinical Director for Obesity and Diabetes, NHS England stated that patient education, awareness and active and not passive participation in managing their condition is the key in treatment and management of the condition for a better outcome.

In his welcome address, Rt Hon Keith Vaz MP, Chair, APPG for Diabetes stated, “Today's conference brings together Members of Parliament, health ministers, leading experts in diabetes care and research from the United Kingdom and the world…. The conference will focus on sharing knowledge and best practices from a wide variety of stake holder, and it will reflect on diabetes from an international perspective, enabling delegates from to learn from other countries' different ways of managing diabetes.” – The conference did just that.

The author, Mr. Chidi Anyaeche, the Business Development Director of JB Consulting (MDP) Limited (www.jbconsulting.co.uk), a UK based in-vitro diagnostic and pathology consulting company and member of British In-vitro Diagnostics Association (BIVDA) was an invitee to the conference.