In Russia,
the care of diabetes is managed through local hospitals.
Strip provision is low, and in many cases blood testing two or three times
a week is the norm.

Strips are for sale in Moscow and other large cities,
but the cost is disproportionate to salaries.

Furthermore, foot complications
and the risk of amputation are enormous in Russia.

It is thought that Russia may place as high as third in the register of
countries with the highest number of diabetics in the world, with an estimated
9,613,000 cases.

However, the disease is thought to be undiagnosed in as
many as fifty per cent of cases. The lack of management by undiagnosed
patients is a major contributing factor to the number of amputations per
year. The awareness of the danger of diabetic foot ulcers is simply not
there.

The number
of diabetes sufferers in Africa remains uncertain, although and IDF estimate
from 2000 put the figure at 7.5 million diabetic adults between 20 and
79 years of age. It is thought that this figure is now much larger.

The
WHO (World Health Organisation) and the IDF (International Diabetes Federation)
estimate that the diabetes population will double over the next twenty
five years in Adrica.

This raises enormous healthcare questions, as all African countries are
already struggling to cope with the diabetes burden. Awareness is regarded
as being poor, and the concentrations of the disease vary considerably
between different ethnic groups.

Type 1 diabetes, although still rare in
many areas, is becoming increasingly more prevalent. IGT (Impaired Glucose
Tolerance) is also becoming problematic, and exceeds 30 per cent in many
African countries.

The World
Health Organisation estimated the following diabetes populations by country
for 2000, and 2030.

The number of people in the diabetes is increasing rapdily.
Experts are clear to indicate that the growing obesity problem was overwhelmingly
responsible for the rise.

The figure was compiled from English GP records
and data from diabetes UK for the other nations.

The figure was a quarter
of a million higher than previous estimates.

Diabetes UK estimates that there are 148,000 cases of diabetes in Scotland,
47,000 in Northern Ireland, and 92,000 in Wales. This figure was combined
and added to Department of health data that revealed some 1,766,391 cases
in England.

Obesity figures vary, but some experts believe that as many as 65 per cent

of men and 55 per cent of women in the UK are overweight or obese.

Over two
million people in Canada now suffer from diabetes, and by the 2015 it is
predicted that this number will rise to three million. The type 1/ type
2 split is standard, with 10 per cent suffering from type 1 diabetes.

It is type 2 diabetes that is contributing most to what could become a
problematic healthcare situation. Type 2 is increasing rapidly, with several
factors feeding the surge.

These include an aging population, increased
rates of obesity, and the spread of sedentary lifestyle.

Canada also has a large ethnic minorities population, and a population
of aboriginals who face much higher diabetes risks.
The ethnic minorities at risk include Asians, South Asians, African and
Hispanic people.

Diabetes already contributes to the death of over 40,000
Canadians every year. A Canadian who is suffering from diabetes is up to
four times as likely to die age 35 than a 35-year old person without diabetes.

The financial burden of diabetes on the Canadian healthcare system is also
enormous, and likely to increase considerably into the future.

According
to a Diabetes Australia report, Australia had an estimated 1.2
million diabetics.

Recent research conducted in Australia estimates that half of all Australian
diabetics do not know that they have the condition.

Diabetes levels in
Australia have doubled since the early 1980s.

Diabetes, combined with the associated complications that can develop when
the disease is present for some time (including neuropathy, heart disease
and kidney disease) contribute to an annual healthcare bill for diabetes
in Australia that is estimated to be above $1 billion and climbing fast.

Amongst the Aboriginal population, the situation is even more serious.

The figures
for Ireland are smaller than the UK, yet the scale of the problem when considered in
terms of the population size is not minor.

In Ireland, it is estimated
that there are well over 200,000 type 2 diabetics, and a further 100,000
people who have high blood glucose levels who are undiagnosed because they
have not exhibited complications.

At current trends of obesity levels,
the figure will double in the next decade.

The level of the population with impaired glucose tolerance is unknown,
but it is expected that within the next five years half of this population
will develop diabetes.

The number of people with diabetes in China is estimated to be 1 in 10 out of Chinese adult.

Compared with the UK, where diabetes affects about 1 in 20 adults, the state of diabetes in China is alarming.

During the 21st Century millions of new cases of diabetes are occurring each year.

However, an accurate figure for diabetes in China is hard to estimate,
as many cases are thought to be undiagnosed.

China is thought to have edged
ahead of India, becoming the country with the highest population of diabetes
in the world.

Like many other countries, the principal pre-cursor to the development
of type 2 diabetes is obesity.

Type 2 diabetes in China

As China has become modernised, the sedentary
lifestyle favoured by western people has infiltrated Chinese culture, leading
to people eating more and exercising less.

Until just over a decade ago, type 2 diabetes was very rare in China.

Growing problem

However,
in the run up to the end of the millennium, the scale of the problem has led China to become a country with one of highest diabetes prevalence figures (percentage of people with diabetes).

The urban areas, where economic development is at its fastest and traditional dietary practices are eroded most quickly, are the hotspots for diabetes in China.

Diabetes is rapidly becoming one of the world’s most common diseases. One of the worst suffering countries is the USA where diabetes is the seventh leading cause of death among

US
citizens.

An estimated 24 million Americans (8% of the population) have been hit by the diabetes epidemic in the US, and a further 17.9 million being diagnosed. Around 90% of the country’s diabetics have

type 2 diabetes

This is a stark contrast from the 21 million diabetics in 2002, a figure that
constituted approximately 7% of the total population. It was estimated
that 14.6 million people had been diagnosed with the condition in 2002, with 6 million unaware that they were suffering from the disease.

Serious health problems brought on by diabetes are a major issue in America and affect a significant number of people.

Pre-Diabetes in America

Pre-diabetes
is at epidemic levels in the United States, with a reported figure of 41 million people affected/ Long-term damage to the body, later manifested as the complications of diabetes, may already be occurring in pre-diabetics.

In American,

gestational diabetes
affects about 4% of all pregnant women.

There are about 135,000 cases of gestational diabetes in America every year. Furthermore, in American, one out of every ten healthcare dollars is spent on treating or managing diabetes and its related complications. In 2002, the total economic cost for the year of diabetes healthcare was estimated at $132 billion.

According to official figures, roughly three out of five diabetics develop at least one of the other serious health problems associated with the disease such as

heart disease, stroke, eye damage,

kidney disease, nervous system damage and

foot problems
that can lead to amputations.

However, many people with Diabetes Mellitus Type 2 (type 2 diabetes), which accounts for around 90% to 95% of all diagnosed cases of diabetes, develop more than one other serious health problem. Statistics show that approximately:

• 1 out of 10 people (10.3%) with the disease has 2 other serious health problems
• 1 out of 15 people (6.7%) with the disease has 3 other serious health problems
• 1 out of 13 people (7.6%) with the disease has 4 or more other serious health problems

The US government is desperately trying to stem the outbreak of diabetes. Doctors and health organisations across the country are increasing their efforts in getting the public to adopt healthy lifestyle changes, that can protect against type 2 diabetes, or at the very least, help diabetics control the disease.

Diabetes Research

Researchers in the US are also doing their part by constantly looking to develop new drugs to help people manage their diabetes more effectively.

Unfortunately, reports show that Americans are making slow progress in adopting such changes to their daily routines. The country’s fast food lifestyle combined with a lack of exercise means a high percentage of both adults and children in the US are either overweight or obese, and are therefore more likely to develop diabetes at some stage.

There is also a concern that some type 2 diabetes medications, such as Avandia, are increasing the risk of heart attack, which has led to many diabetics abandoning their medication and leaving their diabetes untreated.

The financial cost of diabetes in America

In 2008, the diabetes epidemic sweeping across America cost the nation an estimated $218 billion (£150 billion), equal to roughly 10% of all health care expenditure by the US government and the public.

The enormous figure takes into account direct medical care costs, from insulin and pills for controlling patients’ blood sugar levels to amputations and hospitalisations, plus indirect costs such as lost productivity, disability and early retirement.

Last year’s costs (medical and indirect) for people known to have type 1 or type 2 diabetes were estimated at $174.4 billion combined. The rest of the figure consists of estimates for Americans who haven’t yet been diagnosed ($18 billion), women who develop diabetes temporarily during

pregnancy
– known as gestational diabetes – ($636 million), and those on course to develop diabetes – an increasingly common condition called pre-diabetes ($25 billion).

Furthermore, between 1994 and 2007 the average number of diabetes medications prescribed per patient rose from 1.14 to 1.63, while estimated yearly patient visits for diabetes care increased from 25 million to 36 million over the same period.

Over 30 million
have now been diagnosed with diabetes in India. The CPR (Crude prevalence
rate) in the urban areas of India is thought to be 9 per cent.

In rural
areas, the prevalence is approximately 3 per cent of the total population.

The population of India is now more than 1000 million: this helps to give
an idea of the scale of the problem.

The estimate of the actual number
of diabetics in India is around 40 million.

This means that India actually
has the highest number of diabetics of any one country in the entire world.

IGT (Impaired Glucose Tolerance) is also a mounting problem in India.

The
prevalence of IGT is thought to be around 8.7 per cent in urban areas and
7.9 per cent in rural areas, although this estimate may be too high. It
is thought that around 35 per cent of IGT sufferers go on to develop type
2 diabetes, so India is genuinely facing a healthcare crisis.

In India, the type of diabetes differs considerably from that in the Western
world.

Type 1 is considerably more rare, and only about 1/3 of type II
diabetics are overweight or obese.

Diabetes is also beginning to appear
much earlier in life in India, meaning that chronic long-term complications
are becoming more common. The implications for the Indian healthcare system
are enormous.

Diabetes is finally being recognised as a

global
epidemic, with the potential to cause a worldwide healthcare crisis. Over 463 million people are currently living with diabetes in 2019, or 9.3% of the population.

Where is the diabetes at its worst? Which countries are most seriously affected by diabetes and how is this going to change?

It is estimated that currently diabetes affects 1 in 11 of the world’s adult population. The prevalence is higher in urban (10.8%) than rural (7.2%) areas, and in high-income (10.4%) than low-income countries (4.0%). Just over 1 in 2 people living with diabetes do not know that they have diabetes.

According to estimates by the International Diabetes Federation, this figure is set to increase to by 25% in 2030 and 51% in 2045.

This is over and above the estimates set out in a 2019

WHO
(World Health Organisation) report. At this time, they forecast that by 2045 there would be 548 million diabetics worldwide.

Diabetes is growing faster than predicted.

For this reason this section is broken up into national profiles, by reading all of which it is possible to gain a basic global overview.

• 
  Diabetes in the UK
• 
  Diabetes in Scotland
• 
  Diabetes in Wales
• 
  Diabetes in Ireland
• 
  Diabetes in America
• 
  Diabetes in India
• 
  Diabetes in Africa
• 
  Diabetes in China
• 
  Diabetes in Australia
• 
  Diabetes in Russia
• 
  Diabetes in Canada

The diabetes situation in each country is different in terms of the scale of the problem, the

type of problem
and the ability of the healthcare systems to deal with the problem.