Diabetes care in figures: current pitfalls and future scenario

Abstract

Diabetes mellitus (DM) epidemic-on a global scale-is a major and snowballing threat to public health, healthcare systems and economy, due to the cascade of pathologies triggered in a long-term manner after the DM manifestation. There are remarkable differences in the geographic disease spread and acceleration of an increasing DM prevalence recorded. Specifically, the highest initial prevalence of DM was recorded in the Eastern-Mediterranean region in 1980 followed by the highest acceleration of the epidemic characterised by 0.23% of an annual increase resulted in 2.3 times higher prevalence in the year 2014. In contrast, while the European region in 1980 demonstrated the second highest prevalence, the DM epidemic developments were kept much better under control compared to all other regions in the world. Although both non-modifiable and modifiable risk factors play a role in DM predisposition, cross-sectional investigations recently conducted amongst elderly individuals demonstrate that ageing as a non-modifiable risk factor is directly linked to unhealthy lifestyle as a well-acknowledged modifiable risk factor which, in turn, may strongly promote ageing process related to DM even in young populations. Consequently, specifically modifiable risk factors should receive a particular attention in the context of currently observed DM epidemic prognosed to expand significantly over 600 million of diabetes-diseased people by the year 2045. The article analyses demographic profiles of DM patient cohorts as well as the economic component of the DM-related crisis and provides prognosis for future scenarios on a global scale. The innovative approach by predictive diagnostics, targeted prevention and treatments tailored to the person in a suboptimal health condition (before clinical onset of the disease), as the medicine of the future is the most prominent option to reverse currently persisting disastrous trends in diabetes care. The key role of biomedical sciences in the future developments of diabetes care is discussed.

Keywords: Adolescence; Comorbidities; Costs; Diabetes mellitus; Economy; Epidemic; Health policy; Medical care; Pitfalls; Predictive preventive personalised medicine; Prevalence; Prognose.

Fig. 1

Permanently increasing prevalence of diabetes patients registered worldwide. With a single asterisk, the prognoses made in 1980s are marked. An expected increase in diabetes prevalence has been further updated in the early 2000s marked with a double asterisk clearly demonstrating that prognoses are getting more and more pessimistic; however, actually registered diabetes prevalence (marked in red colour) outnumbers any pessimistic prognosis provided earlier [1]

Fig. 2

Prevalence of DM on a global scale: retrospective comparative analysis in the period of time from the year 1980 till 2014 [3]

Fig. 3

The entire DM patient’s pool (in million of patients) stratified by the age as registered in the year 2015; prognostic estimations for the corresponding age-groups are made for the year 2040 [7]

Fig. 4

DM patient distribution profiles (in million) between the urban and rural areas as documented for the year 2015 and prognosed for the year 2040 [7]

Fig. 5

Gender-related patient distribution profiles (in million): actually (year 2015) registered patients versus prognoses for the year 2040 [7]

Fig. 6

Current DM prevalence documented for the year 2015 versus prognostic estimations for the epidemic development over the next 2.5 decades; “1st” is used to demonstrate the country with the highest number of DM patients in corresponding regions [7]