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Diabetes: The 21st Century Epidemic

August 2007
Diabetes: The 21st Century Epidemic

"For the first time in history, more people in the world are overweight than are malnourished, and more than 200 million people across the globe are afflicted with diabetes, a disease that can impact virtually every system in the body. By 2030 that number will double," says Venkat Narayan, Hubert Professor of Global Health and Epidemiology in Emory's Rollins School of Public Health (RSPH). In the U.S., 21 million suffer from diabetes, and one in three people are projected to develop the disease at some point during their lifetime. "Excess food and a modern sedentary lifestyle are clearly linked to the diabetes epidemic," says Narayan. "In addition, we are living longer, and age is an important risk factor for developing diabetes."

Obesity and overweight are now dramatically on the rise in low and middle income countries, particularly in urban settings. The corresponding rise in diabetes rates has led researchers to coin a new hybrid term: ‘diabesity.' "We are finding two very important things. In rich countries like the U.S., diabetes has developed as a bigger problem among poorer people. And when you talk in global terms, the number of diabetes sufferers are increasing at the most rapid rate in India, China, Latin America, and increasingly, Africa," Narayan says. He believes that economic development plays a bigger role than genetics. "A lot of good things come from development, but it also results in less physical activity, more unhealthy foods, and a greater availability of food."

About 95% of people with diabetes have Type 2 diabetes. Believed to be a disease of middle age just a few decades ago, Type 2 today is increasingly diagnosed in teens and younger children, primarily the result of obesity and lack of exercise.

The RSPH is expanding its global partnerships in diabetes, including developing a strong collaboration with a large diabetes center in Chennai, India—namely, the Madras Diabetes Research Foundation. Student exchanges are already underway, and the RSPH is seeking funding for a proposed Emory Global Diabetes Research Center which will be matched by the Madras foundation. "We can bring our respective strengths into this partnership and make the Global Diabetes Research Center a true example of a center that undertakes world-class research to solve diabetes globally," say Dr. Mohan, Director of the Madras Diabetes Research Foundation.

"That's the kind of relationship we want: one of partnership, not of dependency. We are seeking a fruitful, long-term partnership where there is mutual respect and mutual benefit. That is the nature of global health," Narayan says, adding that the partnership will provide important public health benefits and a wealth of research and learning opportunities for Emory students and researchers. "We are living in an interconnected world, and the question is how do we take advantage of that and come up with creative solutions to global problems." A large prevention study in the U.S. has shown that lifestyle interventions—increasing physical activity, controlling weight—could reduce the progression of at-risk people to diabetes by 50% to 60%. Similar studies in China, Finland, India, and on smaller scale, Sweden, also indicate that interventions can reduce the rate of progression by up to 60%.

"If changes can be implemented through aggressive public health policy, major progress can be made toward arresting this epidemic," Narayan says. "These intervention studies clearly provide a lot of hope, and we understand more and more what causes this disease. More breakthroughs are definitely on the horizon."

The information in this article is re-printed by permission (from Diabetes: the 21st century epidemic) and provided by K.M.Venkat Narayan, MD, MSc, MBA, FRCP, Hubert Professor of Global Health & Epidemiology, Hubert Department of Global Health, Rollins School of Public Health, and Professor of Medicine, School of Medicine, Emory University, Atlanta, USA.

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