A few last words on IDF! There was interesting data presented on DREAM (wash out from the trial) that we think bodes pretty well for TZDs, except that the weight gain associated with these drugs continues to be a nagging problem. We'll come back on this and the slew of other interesting talks we heard in our last two days in South Africa.
In the meantime, we reiterate again how lucky we feel to be based in a first world country. We stopped at a slew of booths today where diabetes organizations told us the status quo in their countries. For example, in Mozambique, type 1 patients when diagnosed get a grim prognosis - typically they die after one year because insulin is too hard to get reliably. I know I don't even give a second thought to having insulin as a lifeline - but I've never worried about the availability. Never for a second. Clearly I am among a lucky minority.
IDF warned this week that the expected explosion of diabetes worldwide may threaten global economic advancement. Some might think this exaggeration, but to be sure, the increased prevalence of diabetes will disproportionably disturb the economies of low and middle-income countries.
Diabetes has significant and damaging effects on economies because of increased health costs, disability, and loss of life. According to the IDF, the cost of diabetes treatment and prevention will rise to more than $302.5 billion by 2025. While the majority of people living with diabetes in 2025 will be in low and middle-income countries, these countries account for less than 15% of global diabetes prevention and care spending. By comparison, US accounts for more than 50% of global diabetes spending, even though it is home to only 8% of the world’s population living with diabetes. And if 8% seems like an epidemic to us, you can imagine what it feels like elsewhere, where good treatments can't for a second be counted on.
Although effective and inexpensive diabetes treatments exist, these treatments are considerably underused in low and middle-income countries. According to new estimates by the IDF, in some of the world’s poorest countries the national diabetes-care spending could not even cover the annual wholesale cost of sufficient quantities of a generic high blood sugar treating oral agent. One explanation for the underutilization of diabetes drugs in the developing world is that in many instances families pay a large share of health-related costs directly out of pocket. For example, on average families in Latin America pay for about half of the costs of diabetes care directly out of pocket. In India, on average, people spend a third of their total income on private care.
More widespread use of diabetes treatments in low or medium-income countries would reduce the prevalence of life-threatening complications related to diabetes, such as stroke and kidney failure, and might result in an overall cost saving because diabetes-related complications are more costly to treat.