New estimates published this week in The Lancet indicate that more than 1·31 billion people could live with diabetes by 2050 worldwide. That’s 1·31 billion people living with a disease that causes life-altering morbidity and high mortality rates and interacts with and exacerbates many other disorders.
Type 2 diabetes accounted for 90% of all diabetes prevalence. Most of this burden is attributable to social risk factors—such as high BMI, dietary risks, environmental and occupational risks, tobacco use, alcohol use, and low physical activity—that thrive on the obesogenic way our environments are designed and the inequitable way we organize our resources and societies.
The focus remains on biomedical interventions and new devices.
Estimates for the global type 2 diabetes drugs market over the next decade vary widely, with some reaching more than US$100 billion. Overall, global diabetes-related health expenditure will rise to $1054 billion by 2045. The excitement and utility surrounding GLP-1 agonists and newer drug combinations that help control blood sugar and reduce body weight are understandable. But as Rupa Marya and Raj Patel write in their book Inflamed Deep Medicine and the Anatomy of Injustice, the solution to unhealthy and unfair societies is not more pills but to re-evaluate and re-imagine our lives to provide opportunities to tackle racism and injustice and to prevent the significant social drivers of disease.
STAT recently reported that “rising rates will be driven by type 2 diabetes, and while obesity is a primary risk factor for type 2, the new GLP-1 drugs aren’t the answer. Ozempic, Wegovy, and Mounjaro are highly effective in treating diabetes and obesity, but addressing diabetes worldwide requires not only medical interventions but also broad changes to the environments people live in, the Lancet editors write.”
The data does indicate that diabetes is very much a global crisis, but here in the US, we still don’t dare to address the real reasons: lack of exercise, portion controls, and too much processed food.
Big pharma would have us believe that the new weight loss drugs are the answer, but stories are already starting to detail patients who have stopped taking them due to side effects, costs, and the inconvenience of staying on them for a lifetime. I don’t understand why insurers require patients prescribed these drugs to meet with a registered dietician and wear an activity monitor to determine if they are getting enough exercise.
I put on weight when I crashed my bike and broke my shoulder long ago. Today I eat smaller portions, try and ride my bike 100 miles a week, and lose weight. It was a decision based on my need to stay as healthy as possible.
Our healthcare costs will eat away at our GNP mainly because too many of us use food as an excuse to feel good. Until the medical community puts politics aside and determines to tackle diabetes this crisis will excel and bite us in the ass.