PR Explainer: Pakistan’s Diabetes Problem
Rohini Reenum
On 14 November, a press briefing was organized at the Karachi Press Club on the occasion of the World Diabetes Day. The theme this year was “Breaking Barriers, Bridging Gaps.” Several doctors and experts highlighted the rising number of diabetes cases across the world and emphasized the urgency of immediate intervention. In this regard, the President-Elect of the Pakistan Endocrine Society, Dr Ali Asghar noted that “The global prevalence of diabetes has seen a dramatic increase over the last few decades, with patient numbers expected to rise from 537 million in 2024 to 783 million by 2045.” He further informed that around 33 million of these cases are in Pakistan alone and this number is increasing annually. 

What are the issues?
First, the rising number of cases. A recent editorial in Dawn has put the number of diabetics in the country between 33 to 36 million which means that around one-fourth of the adult population suffers from the disease. Additionally, an editorial in The News International has highlighted that the often-cited figure of 36 million is based on data for 2022 and thus does not necessarily reflect the current numbers. Further, experts have cautioned that this 36 million figure number could double by 2045 in case of inaction. According to the International Diabetes Federation (IDF), diabetes prevalence in adults in Pakistan stands at a whopping 26.7 per cent. What is even more concerning about this rise is that the diabetes rate has risen to 30.9 per cent among women, and women are generally also socio-economically disadvantaged, thus hindering their ability to access treatment and care. Some factors leading to an increase in cases include “growing urbanization, poor dietary habits, sedentary lifestyles, and increasing rates of obesity.” This pertains particularly to the younger population. 

Second, a large number of cases remain undiagnosed. An editorial in Dawn revealed that a quarter of the aforementioned 33 million cases in Pakistan remain “undiagnosed.” This impedes/complicates government intervention as effective diagnosis and availability of aggregate numbers are a prerequisite for any kind of government/governance intervention in tackling the spread or prevention of disease.

Third, a lack of a holistic approach to treatment. The primary focus of treatment is on regulating a patient’s blood sugar level which is also the primary indicator/diagnostic of the disease. However, experts have increasingly highlighted links between diabetes and mental health disorders. For instance, a board member of the PharmEvo Research Forum, Dr Masood Jawaid has pointed out the link between diabetes and anxiety and depression. Referencing a survey carried out with 1600 diabetic patients, he revealed that about 47 per cent of them also suffered from anxiety and depression. This means that this link has been discerned in one out of two diabetic patients. However, Dr Jawaid lamented that doctors hardly take this correlation into account while treating diabetics. Similarly, an editorial in Dawn emphasized that “Urgent action is needed to ensure that personal well-being is prioritized in diabetes care.” Another fact complicating treatment is that most diabetic patients also develop co-morbidities like hypertension and heart disease and this factor needs to be taken into account. According to an editorial in The News International, around three million diabetics suffer from foot ulcers that can result in amputations, 16-20 percent have developed eye problems and 28 per cent are suffering from kidney failure. These are significant health problems, some of them life-threatening and they can render a diabetic’s condition debilitating.

Fourth, the disproportionate impact on low and middle-income countries. An editorial in Dawn has highlighted that while an explosion in the number of diabetics is a global phenomenon, it impacts “low and middle-income countries” disproportionately. This correlation has a two-fold impact on these countries: While these countries commonly do not possess a robust public health infrastructure thereby limiting access to treatment, the significant increase in numbers further burden the barely existing infrastructure. Access to treatment, however, is impacted adversely not just by a general lack of/ limited availability of public health infrastructure, it is also made inaccessible by poverty that is ubiquitous in these countries. Government spending on health is also a function of/is proportional to the expanse and robustness of their respective economies. Consequently, low and middle-income countries tend to spend less on the health sector. 

What next?
Experts have suggested that because diabetes is a lifestyle disease, the primary focus should be on prevention. According to the Chief Editor of the Pakistan Journal of Medical Sciences (PJMS) & Pulse International, Shaukat Ali Jawaid, some the preventive measures are “offering fruits instead of sweets on happy occasions, encouraging children to reduce screen time, promoting physical activity, and avoiding junk or processed foods.” On government intervention, experts have argued for public awareness campaigns, facilitating spaces for exercise, and making available affordable and healthy food choices. 

References
“Diabetes challenge,” Dawn, 15 November 2024
“‘50pc of diabetics suffer from anxiety, depression’,” Dawn, 14 November 2024|
“Managing diabetes,” Dawn, 14 November 2024
“Our diabetes epidemic,” The News International, 15 November 2024