Diabetes is a global issue. Diabetes kills and disables, striking people at their most productive age impoverishing families or reducing the lifeexpectancy of older people. Diabetes is a common threat that does not respect borders or social class. No country is immune from diabetes and the epidemic is expected to continue. The burden of diabetes drains national healthcare budgets, reduces productivity, slows economic growth, causes catastrophic expenditure for vulnerable households and overwhelms healthcare systems.
Diabetes is one of the largest global health emergencies of the 21st century. Diabetes is among the top 10 causes of death globally and together with the other three major noncommunicable diseases (NCDs) (cardiovascular disease, cancer and respiratory disease) account for over 80% of all premature NCD deaths. In 2015, 39.5 million of the 56.4 million deaths globally were due to NCDs. A major contributor to the challenge of diabetes is that 30-80% of people with diabetes are undiagnosed.
Population-wide lifestyle change, along with early detection, diagnosis and cost-effective treatment of diabetes are required to save lives and prevent or significantly delay devastating diabetesrelated complications. Only multi-sectoral and coordinated responses with public policies and market interventions within and beyond the health sector can address this issue.
In high income countries, approximately 87% to 91% of all people with diabetes are estimated to have type 2 diabetes, 7% to 12% are estimated to have type 1 diabetes and 1% to 3% to have other types of diabetes. In most high income countries, the majority of children and adolescents who develop diabetes have type 1 diabetes. The relative proportions of type 1 and type 2 diabetes have not been studied in detail in low and middle income countries.
Some 425 million people worldwide, or 8.8% of adults 20-79 years, are estimated to have diabetes. About 79% live in low and middle income countries. The number of people with diabetes increases to 451 million if the age is expanded to 18-99 years. If these trends continue, by 2045, 693 million people 18-99 years, or 629 million of people 20-79 years, will have diabetes. The largest increases will take place in regions where economies are moving from low income to middle income levels. Diabetes estimates have been on the rise for several decades. More than one-third of diabetes cases are estimated to result from population growth and ageing, 28% from an increase in age-specific prevalences and 32% from the interaction of these two. Globally diabetes results in USD 727 billion being spent yearly by people with diabetes only on healthcare, which corresponds to one for every eight dollars spent on healthcare.
Source: International Diabetes Federation Atlas. Eighth Edición.
In Cuba, the diabetic population is 3 – 6% of the total, and the amount of people susceptible of any amputation was 1500 – 3000, before national extension of Heberprot-P® was started. These data are enough to show the magnitude of the challenge that DM represents, and DFU as the major related complication that represent a significant source of morbidity and mortality in diabetic patients. In spite of conventional treatments and the management of this disease, a significant amount of diabetic patients do not respond, and are susceptible of amputations.
In that sense, the Cuban Ministry of Health is working to reduce the mortality rate due to DM from 11 to 7%. To this end, the Ministry supports the work of hospitals with medical expertise and resources for the attention of this disease. The key issues are performing screenings, finding early the hidden DFU, implementing a suitable intensive treatment, and controlling the patient metabolism to avoid later complications of this disease.