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.

Untreated Diabetes: Millions Risk Early Death Because of Poor Diagnosis and Ineffective Treatment

• In the United States alone, nearly 90% of adult diabetics – more than 16 million adults aged 35 and older – have blood sugar, blood pressure, and cholesterol that are not treated effectively, meaning they do not meet widely accepted targets for healthy levels of blood sugar, blood pressure, and cholesterol.

• In Mexico, 99% of adult diabetics are not meeting those targets.

• Up to 62% of diabetic men in Thailand are undiagnosed or untreated for diabetes. This translates to more than 663,000 people in that country.

A new study, published in the Bulletin of the World Health Organization's March edition, has found that millions of people worldwide may be at risk of early death from diabetes and related cardiovascular illnesses because of poor diagnosis and ineffective treatment.

The objective of the study was to examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socio-economic factors.

Researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, who examined diabetes diagnosis, treatment, and management in the US, Thailand, Mexico, Colombia, England, Iran, and Scotland have come to the conclusion that "too many people are not being properly diagnosed with diabetes and related cardiovascular risk factors. Those who are diagnosed aren't being effectively treated. This is a huge missed opportunity to lower the burden of disease in both rich and poor countries."

The percentage of diabetics in the seven countries studied who are reaching International Diabetes Federation treatment goals for blood glucose, blood pressure, and serum cholesterol is very low, ranging from 1% to 12%. The researchers conclude there are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia.

In an attempt to determine the cause of the low rates of diagnosis and effective treatment, researchers examined a range of factors and were surprised to find that “no large socio-economic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management.”

"We were very surprised to see that wealth did not have a big impact on diagnosis and treatment," said Dr. Emmanuela Gakidou, the paper's lead author and an Associate Professor of Global Health at IHME. "And in the three countries where we had health insurance data, we thought it was noteworthy that health insurance actually played a much bigger role than wealth, especially in the US."

In the US, people who had insurance were twice as likely to be diagnosed and effectively treated for diabetes as those who did not have insurance.

The researchers said the findings underscore the need for countries to tackle the growing problem of non-communicable diseases (NCDs) like diabetes, hypertension and cardiovascular diseases in part by gathering better data.

"We don't have enough data from actual physical exams to accurately document the trend in most countries," said Dr. Rafael Lozano, a co-author on the paper and a Professor of Global Health at IHME. "We looked at surveys from nearly 200 countries and only could find data on blood glucose, cholesterol, or blood pressure in seven. We hope that in the build-up to the UN Summit on NCDs this September, countries will make a commitment to more surveys that take blood samples from a representative percentage of the population."

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IHME researchers gathered data and performed their analysis in collaboration with researchers at the University of California, San Francisco, School of Medicine; the Harvard Global Equity Initiative; the National Institute of Public Health in Mexico; and Ramathibodi Hospital in Thailand.

For more information, please visit the IHME website 

Type 2 Diabetes Epidemic in US Linked to Profit-Making Food Industry

According to the 2011 National Diabetes Fact Sheet released by the United States Centers for Disease Control (CDC) on January 26, last year saw an increase in the numbers of people with diabetes in virtually every age category.

The federal agency reports that some 25.8 million Americans, or 8.3 percent of the total population, have diabetes. Fully a third of these individuals do not know that they have the disease and are unaware of the serious risks it creates for their health. In a staggering indictment of the state of public health in the US, the CDC found that a further 79 million people in the country are prediabetic, meaning that their blood sugar levels are elevated, but not yet to the point where they meet the criteria for a full diabetes diagnosis.

Even these stark statistics likely under-report the real situation, with research showing that 35 percent to 40 percent of deceased diabetics did not have the disease listed anywhere on their death certificates.

Ninety percent of diabetics in the US have Type II diabetes, which, as the CDC report points out, is preventable. Once a diagnosis has been made, the severity of the complications can be dramatically reduced with timely and continuing care, including a careful combination of diet, exercise, often oral medication and, not infrequently, insulin administration.

However, what the CDC report fails to note is that such a high level of medical attention is widely unavailable to millions of Americans, who are unable to afford health insurance. With growing poverty, increasing numbers of people cannot buy nutritious food or the glucose test strips needed to monitor sugar levels. For families working multiple jobs and handling the stress of endless financial problems, adequate exercise is also often out of reach.

The rise in the incidence of Type 2 diabetes has come alongside a decline in the overall quality of nutrition in US society and a sharp growth in obesity. These processes are bound up with subordination of the food industry to the profit motive, a fact that has even garnered attention in the mainstream press. In May 2009, the news magazine Businessweek observed that “evidence is mounting that the obesity crisis is not the result of a lack of personal responsibility,” going on to note that “the processed food industry’s practices may be just as much, if not more, to blame.”

The omnipresence in the food industry of federally subsidized corn carbohydrates and dairy fats, coupled with advertising campaigns aimed at the most vulnerable segments of the population—the young and the working poor—have been cited in studies as chief reasons behind the enormous weight gains of the American people over the last 40 years.

At the 2009 European Congress on Obesity in Amsterdam, Dr. Boyd Swinburn of Deakin University in Melbourne, Australia, pointed out to Heartwire that the food industry has been targeting the most impressionable layers of society. “They’ve worked their marketing out to the nth degree,” he noted.

In 2009, Kelly D. Brownell from the Rudd Center for Food Policy and Obesity at Yale University and Kenneth E. Warner from the University of Michigan published an article entitled, “The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar is Big Food?” The authors noted:

“To protect profits, the food industry must avoid perceptions that it is uncaring and insensitive, ignores public health, preys on children, intentionally manipulates addictive substances, and knowingly, even cynically, contributes to death, disability, and billions in health care costs every year. Stated another way, it cannot afford to look like tobacco.”

As Brownell and Warner point out, the food industry buys access to key associations, including the professional organization for US nutritionists, the American Dietetic Association. The Association regularly publishes “fact sheets” on nutritional advice for the public. The food industry pays $20,000 per sheet, which industry lobbyists then write for the association.

According to Brownell and Warner, the food industry’s strategy for deflecting attention from its practices for the poor state of nutrition in the US includes the following:

“Focus on personal responsibility as the cause of the nation’s unhealthy diet; raise fears that government action usurps personal freedom; vilify critics with totalitarian language, characterizing them as the food police, leaders of a nanny state, and even ‘food fascists,’ and accuse them of desiring to strip people of their civil liberties; criticize studies that hurt industry as ‘junk science’; emphasize physical activity over diet; state there are not good or bad foods, hence no food or food type (soft drinks, fast foods, etc.) should be targeted for change; plant doubts when concerns are raised about the industry.”

On the very day of the CDC’s 2011 Fact Sheet release, Robert Langreth of Forbes noted that sections of the pharmaceutical and health care industry were pleased with the latest report.

“What’s bad news for Americans is good news for companies that make diabetes treatments. One company that has ridden the obesity and diabetes epidemic like no other is the Danish company Novo Nordisk…. Other companies helped by the bad news include Merck (of the popular diabetic pill Januvia), Allergan (obesity surgery supplies), Orexigen Therapeutics (new obesity drug pending FDA approval).”