World Diabetes Day: Affluent lifestyles leading to rise in diabetes

Te 14 November is World Diabetes Day and due to the increasing number of people with diabetes worldwide, the need to recognise the global threat this disease poses has been observed by the United Nations (UN), who passed a resolution in December 2006 to mark this UN observed day.

Two types of diabetes occur: type 1 and the more common type 2, brought on by lack of exercise and obesity. Initially type 2 diabetics are treated with oral anti diabetic agents, but as the condition is progressive these type 2 diabetics will become insulin dependant.

The high incidents of diabetes underlie the importance of an effective and convenient treatment plan. Treatment needs to be convenient and easy so that diabetics are encouraged to take their medication, thereby reducing the medical complications of high sugar levels.

Utilising advanced technology, biologics have led to a vast improvement in the quality of life of diabetics, by allowing for treatments that are easy to comply with. Biologics' mechanisms of targeting specific areas in the human body, ensure a much improved treatment plan and outcome.

This year World Diabetes Day focuses on children and adolescents, as diabetes is increasing in incidence as a childhood disease due to lifestyle changes. Often misdiagnosed or diagnosed too late, in many poorer parts of the world where access to insulin is not always available, children are dying of type 1 diabetes.

Professor Derick Raal is Head of the Endocrinology Department at Johannesburg Hospital and stresses type 2 diabetes has reached epidemic proportions due to the lifestyle changes occurring across the world. “An irony of type 2 diabetes is that positive economic developments such as increased wealth and lifestyle are all leading to a higher prevalence of type 2 diabetes. We have engineered exercise out of our lives.”

Traditionally known as adult onset diabetes, the pattern of type 2 diabetes is changing due to increased consumption of high fat, energy rich food combined with decreased physical activity by the youth, leading to type 2 diabetes now being diagnosed among the young as well.

Type 1 diabetes develops predominately in children and young adults and is an auto immune reaction or self-destruction of the beta cells in the Islets of Langerhans in the pancreas, with the cause not yet fully understood. The body then starts producing antibodies against the beta cells.

This process of self-destruction in the pancreas can occur rapidly or slowly up to a period of five years, before all insulin production stops. When this happens, blood glucose starts increasing. Only through the use of insulin therapy can this loss be compensated for and blood glucose controlled.

Type 1 diabetics will need insulin to survive for the rest of their lives. Hence, the need for the treatment plan to be ‘compliance friendly' i.e. for the insulin to be easy and convenient to administer.

A new treatment option that provides improved blood sugar control and flexibility, with fewer problems, is a biologic called insulin analogue. “A diabetic can now wait till they are actually about to eat and inject their insulin analogue. This flexibility makes a significant difference to people whose schedules are erratic and gives them greater control over their lives.”

The advances in the development of these biologic insulins makes it possible for a diabetic to live a normal life and not be encumbered by the dosing of the insulin.

Nocturnal hypoglycaemia, or low blood sugar, is a condition where the nighttime sugar level drops during sleep. In extreme cases it could lead to a coma, and this knowledge can create undue stress for a patient and their family. With insulin analogues there are fewer incidences of nocturnal hypoglycaemia.

Thus the use of insulin analogues is becoming more common as a treatment form. “Insulin analogue as a treatment option will allow patients to have a much improved quality of live. Essentially it's comparing driving an entry level car to driving a luxury model.”

Reimbursement of biologics has been a topic of debate for medical schemes, yet economic advisor to the biologics working group Professor Tienie Stander says diabetes contributes approximately 1.1% to the burden of disease for the total South African population.

“The utilisation of insulin in the treatment of diabetes has increased over the past years. This increase was mainly due to the increased usage of the newer type insulin called insulin analogues. Whereas human insulin consisted of 88% of the total insulin sales in 1999, by 2006 insulin analogues represented 63% and human insulin represented only 37% of sales.”

Stander continues to explain how in 2006, versus 2005, sales in human insulin increased by 2%, compared to insulin analogues, which increased by 22% (compared to 2005).

“The main reason for this switch from human to analogue insulin could be attributed to better patient quality of life and compliance to treatment. In 2006 insulin analogue cost the private healthcare industry approximately R2.64 per beneficiary per month compared to R1.54 for human insulin.”

Thus through better prevention, detection and effective management of diabetes, many of the complications associated with the disease, which accounts for much of the economic burden, could be averted.

On behalf of: Biologics Working Group
Nusreen Khan
011 655 2700