New IDF Charter Promotes Rights of People With Diabetes

THE International Diabetes Federation (IDF) today launched the first ever Charter setting out the fundamental rights of more than 300 million people living with diabetes.

The landmark document, which forms part of IDF’s Advocacy Toolkit for the United Nations High-Level Summit on Non-Communicable Diseases (NCDs), places the rights of people with diabetes, their parents and careers into three focus areas: the rights to care; information and education and social justice, whilst at the same time acknowledging the responsibilities held by people with diabetes.

The publication of the International Charter of Rights and Responsibilities of People with Diabetes comes at a crucial time. As the global diabetes epidemic continues to escalate, IDF estimates that the number of people with diabetes will rise to 500 million within a generation, killing 4 million people each year and costing the global economy US$378 billion in health care spending.

Priority Actions for the Non-Communicable Disease Crisis

IDF will use the Charter as a powerful campaigning tool to counteract the discrimination and stigma millions of people with diabetes still face, largely due to ignorance and misconceptions surrounding the disease.

In many parts of the world, this promotes a culture of secrecy that can create barriers to services, employment, and even marriage, and may stop people with diabetes playing an active role in society.

Raising awareness about the rights of people with diabetes is a key element of IDF’s demand for coordinated and concerted international action to tackle the diabetes epidemic before, during and after the UN High Level Summit on non-communicable diseases (NCDs) to be held this September in New York.

“Both children and adults alike are denied both the rights to life and health when their diabetes goes undetected or they lack access to affordable technologies and medicines such as insulin, oral blood glucose lowering agents and other necessary medications” said Sir Michael Hirst, President-Elect, IDF.

“This is a ground-breaking document that gives Governments and organizations clear guidance on what the fundamental rights to life, health and freedom from discrimination mean to people with diabetes. It is a gold standard to which they should aspire.”

Articles contained within the Charter urge governments and public authorities to commit to making health care accessible for all and creating conditions that allow people with diabetes to have as normal a life as possible.

IDF encourages all Governments and organizations to sign-up to and aspire to the Charter principles which underpin the rights to life and health for all people with diabetes

Download the International Charter of Rights and Responsibilities of People with Diabetes (pdf, 2MB)

Charter of Rights FAQ

IDF Advocacy Toolkit

IDF Endorses Early Bariatric Surgery

Return on Investment Make Gastric Bypass Cost-Effective, Claims Position Statement Issued at 2nd World Congress on Interventional Therapies for Type 2 Diabetes

The International Diabetes Federation (IDF) has issued a "radical statement" at an international conference today saying gastric banding and similar surgeries should no longer be a last resort for severely obese people with type 2 diabetes, it is recommending that surgery be considered at a much earlier stage.

"The statement highlights that there is increasing evidence that the health of obese people with type 2 diabetes, including their glucose control and other obesity related comorbidities (conditions), can benefit substantially from bariatric surgery under certain circumstances," says the IDF press release.

The IDF says gastric banding and other surgeries to alter stomach anatomy should now be considered much earlier in the treatment of type 2 diabetes.
Gastric bypass surgery works by reducing the size of the stomach so a person can't eat as much and shortening the length of the intestine so that the body doesn't absorb too many calories. But it might also have the side effect of normalizing blood sugar.

Summary of the 39-Page Statement

• Obesity and type 2 diabetes are serious chronic diseases associated with complex metabolic dysfunctions that increase the risk for morbidity and mortality.
• The dramatic rise in the prevalence of obesity and diabetes has become a major global public health issue and demands urgent attention from governments, health care systems and the medical community.
• Continuing population-based efforts are essential to prevent the onset of obesity and type 2 diabetes. At the same time, effective treatment must also be available for people who have developed type 2 diabetes
• Faced with the escalating global diabetes crisis, health care providers require as potent an armamentarium of therapeutic interventions as possible.
• In addition to behavioral and medical approaches, various types of surgery on the gastrointestinal tract, originally developed to treat morbid obesity (“bariatric surgery”), constitute powerful options to ameliorate diabetes in severely obese patients, often normalizing blood glucose levels, reducing or avoiding the need for medications and providing a potentially cost-effective approach to treating the disease.
• Bariatric surgery is an appropriate treatment for people with type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially when there are other major co-morbidities.
• Surgery should be an accepted option in people who have type 2 diabetes and a BMI of 35 or more
• Surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors.2
• In Asian, and some other ethnicities of increased risk, BMI action points may be reduced by 2.5 kg/m
• Clinically severe obesity is a complex and chronic medical condition. Societal prejudices about severe obesity, which also exist within the health care system, should not act as a barrier to the provision of clinically effective and cost-effective treatment options.
• Strategies to prioritize access to surgery may be required to ensure that the procedures are available to those most likely to benefit.
• Available evidence indicates that bariatric surgery for obese patients with type 2 diabetes is cost-effective.
• Bariatric surgery for type 2 diabetes must be performed within accepted international and national guidelines. This requires appropriate assessment for the procedure and comprehensive and ongoing multidisciplinary care, patient education, follow-up and clinical audit, as well as safe and effective surgical procedures. National guidelines for bariatric surgery in people with type 2 diabetes and a BMI of 35 or more need to be developed and promulgated.
• The morbidity and mortality associated with bariatric surgery is generally low, and similar to that of well-accepted procedures such as elective gall bladder or gall stone surgery.
• Bariatric surgery in severely obese patients with type 2 diabetes has a range of health benefits, including a reduction in all-cause mortality.
• A national registry of persons who have undergone bariatric surgery should be established in order to ensure quality patient care and to monitor both short and long-term outcomes. 1.17 In order to optimize the future use of bariatric surgery as a therapeutic modality for type 2 diabetes further research is required.

Although such operations cost anywhere from $20,000 to $30,000, they will reduce healthcare expenditures in the long run, according to a new IDF position paper on the subject. The surgery, the IDF explains, often normalizes blood glucose levels and reduces or avoids the need for medication.

In addition, curbing diabetes can stave off costly complications such as blindness, limb amputations, and dialysis, says Francesco Rubino, MD, director of the IDF's 2nd World Congress on Interventional Therapies for Type 2 Diabetes.

"When we talk about whether we can afford bariatric surgery, we have to ask what will be the cost if we don't treat the patient. Studies have shown the surgery to be cost-effective. So there is a return on investment," says Francesco Rubino, MD, director of the IDF's 2nd World Congress on Interventional Therapies for Type 2 Diabetes

The IDF puts the lifetime cost of diabetes in the United States at $172,000 for a person diagnosed at age 50 years and $305,000 at age 30 years. More than 60% of this amount is incurred in the first 10 years after diagnosis.

The new recommended indications for performing bariatric surgery on patients who are both diabetic and obese match those announced last month by the US Food and Drug Administration for expanded use of the Lap-Band Adjustable Gastric Banding System (Allergan) to treat obesity.

The IDF recommendations dovetail with Dr Rubino’s previous research on how bariatric surgery alleviates diabetes. He showed that the effect on diabetes is not entirely explained by a person’s weight loss. In fact, the gastrointestinal tract serves as an endocrine organ and a key player in the regulation of insulin secretion, body weight and appetite, which is why altering the GI tract has such profound metabolic effects.

However, the use of bariatric surgery to treat diabetes has sparked controversy in healthcare circles. Critics question the wisdom of wielding a scalpel to solve a medical problem, especially when clinicians have more drugs at their disposal to deal with diabetes.

A study published online last week in the Archives of Surgery has raised doubts about the efficacy of LAGB. Researchers following 151 patients who underwent LAGB for obesity concluded that the procedure yielded "relatively poor long-term outcomes," with nearly half the patients needing their bands removed and 60% overall requiring some kind of reoperation. The authors, who performed the surgeries in question during the mid-1990s, added a caveat: they had used an older dissection technique.

Indeed, the biggest danger is that new weight-loss options likeEndoBarrier (developed in the UK), Lap-Band, Roux-en-Y gastric bypass and sleeve gastrectomy surgery have the potential to encourage overweight people to abandon traditional diet and exercise for procedures that carry some serious risks. That should be a big worry for all diabetes educators and activists.

IDF Sets Up South Asia Office In Mumbai

The International Diabetes Federation (IDF) on November 9 announced the launch of its South Asia regional office at the SL Raheja Hospital in Mahim, reports Indian Express.

(Till recently, the Raheja Hospital also housed the All-India Institute of Diabetes and a great boon to all diabetics, especially from poorer sections. After the corporate healthcare chain Fortis took over Raheja Hospital last year, fees for all services offered by the hospital have been hiked, much to every poor diabetic’s dismay. So it’s strange why IDF chose to set up its office in Raheja and not a public hospital…Has IDF also become a handmaiden of profit-seeking pharma companies?)

Chief Executive Officer of the hospital Ann Keeling said India was chosen as a center due to its growing recognition as an epicenter of diabetes in the world.

“According to available data with IDF and WHO, India has 50.8 million Indians diagnosed with diabetes, and 40 million with impaired glucose tolerance, which means they are at high risk,” said Keeling.

Currently, one in eight Indians suffer from diabetes, which WHO estimates costs the Indian economy US$ 23 billion every year.

She added that 3.8 million die of diabetes annually in India-a figure considerably more than HIV casualties.

“Diabetes is a silent killer, and it is important that policy makers acknowledge this in growing economies like India and China,” said Keeling.

She also pointed out that contrary to trends in western countries, India's population was at risk in its most productive years.

60 Diabetes Seconds May Prevent A Diabetes Life

Given the statistics, no matter where you live, no matter your age or race, fat or thin, you may get diabetes. Did you know type 2 diabetes is the fifth leading cause of death in America and its complications affect every bodily system?

Most people don't know. That's why the International Diabetes Federation (IDF) has launched a series of great-to-look-at, real-people-on-the-street videos.

They're meant to wake you up - they woke me up to how little people know about diabetes - and shake you out of your slumber. Because if you don't know much about type 2 diabetes - the diabetes that's largely preventable - you're sleeping. 

And, trust me, you want to wake up and start taking steps so you don't get it.

I first saw these videos on DiabetesMine, the award-winning diabetes blog of advocate Amy Tenderich. Frankly you need to see them too. I suspect one of these is going to be the one that wakes you up to get tested for diabetes.

First, the shocking statistic most people don't know.

Q: How many people on the planet have diabetes?

Twenty-four million Americans have diabetes. 6 million of them don't know it.

Sixty million people are in line for type 2 diabetes - they have pre-diabetes. Think, there's a reason why they call it that.

One in three Americans will get diabetes in their lifetime. Nearly 1 in 3 children are either overweight or obese. Our future type 2 diabetics, many of whom will get diabetes before they ever leave childhood. That also means they'll have heart disease, high blood pressure, potential blindness, kidney disease and amputations in the prime of their lives.

Q: Which country has the most people with diabetes?

China - 92.4 million. With more than 1,000 McDonalds and 2,000 Kentucky Fried Chickens on street corners.

By 2025 the US, China and India will have the largest populations with diabetes. Researchers at the University of Chicago estimate that in a little more than 20 years the total number of Americans with diabetes will almost double, rising to over 44 million. That's almost 1/7 of the current American population. The World Health Organization projects diabetes deaths will double between now and 2030, and the IDF estimates by 2030 half a billion people around the world will have diabetes.

Q: What do most people with type 2 diabetes die of?

Heart disease, strokes and heart attack. By time you're diagnosed with type 2 diabetes, chances are high you have all the major cardiovascular risk factors.

But first, you can lose body parts.

If you don't have diabetes, keep it that way. Take the American Diabetes Association's risk test. If you're at risk, tell your doctor. It's your life - while you've got it.

Q: More people have diabetes than what two illnesses combined?

Breast cancer and AIDS. Imagine that!

So, how come we don't have a ribbon? 

Maybe it's just the music, but that chokes me up every time. If you have diabetes join the millions this November who'll be spreading the word about diabetes prevention and education. If you have pre-diabetes and are overweight and aren't taking steps right now to shed some pounds and get active, please feel free to join us on World Diabetes Day - you'll be there soon enough.

One last look at diabetes from Novo Nordisk, Diabetes Month 2008. Funny, how little has changed. 

One last question: What country sponsored the 2006 United Nations resolution for World Diabetes Day?

Bangladesh. After the U.S. and most countries in Europe declined.

You don't have to be a superpower to change the world. You don't have to be a superman or woman to stop diabetes now for yourself, your family or your loved ones.

The International Diabetes Federation is an organization of over 200 national diabetes associations in over 160 countries. IDF has been leading the global diabetes community since 1950. IDF's mission is to promote diabetes care, prevention and a cure worldwide. With the incidence of diabetes around the world rising so quickly, for the first time in their 58-year history, the IDF will begin meeting every two years instead of every three.

Thank you Riva Greenberg