The Declaration

Rationale

The formation of the Western Pacific Declaration on Diabetes was born out of the alarming implications of diabetes in the Western Pacific Region.

Globally, there are an estimated 135 million people with diabetes in 1995 with a projected increase to 300 million by 2025. The greater majority of this increase is expected to occur in developing countries. The Regional Plan for Integrated Prevention and Control of Cardiovascular Diseases and Diabetes for the Western Pacific Region 1998-2003 (WHO) states that there are over 30 million people in the Region with diabetes. It predicts that these alarming numbers may double by the year 2025 with a potential 38 million people in China alone, and a further 9 million in Japan.

Increasingly sedentary lifestyles, increasing obesity and aging populations are a feature of at least some sectors of all societies in the Region. As a result, not only is the overall prevalence of Type 2 diabetes rising rapidly but increasing numbers of young people are being infected, including children and adolescents. Preliminary findings from the current Australian national diabetes prevalence survey, AUSDIAB, confirm that in people aged 25 years or older, there is one undiagnosed for every diagnosed person with Type 2 Diabetes. In many non-caucasian populations, especially in the younger age groups the rate of undiagnosed diabetes is even higher. These observations are supported by reports from China, Hong Kong, Japan and Singapore.


Complications
The short term complications of diabetes usually result from delayed diagnosis, lack of or inappropriate treatment, or acute inter-current illness or infection and may be life threatening and are likely to be common in WPR.

Long term complications of diabetes account for the major proportion of both its personal and public health costs. Heart diseases and stroke account for 75% of all deaths among people with diabetes in developed countries. In the WPR, diabetes is listed among the highest 10 causes of death in several countries. Several additional countries rate endocrine and nutritional disorders, which would undoubtedly include a high diabetes component, among the 10 most common causes of death. Diabetes would also be a strong contributing factor in the many countries which list cardiovascular diseases is a common cause of mortality.


Cost of Diabetes
Studies from some developed countries indicate that 5-10% of the total health care budget can be attributed to the care of diabetes and its complications. For example, in Australia, at least US$ 720 million was spent on diabetes health care in 1995 compared with US$ 550 million in 1990. In Japan, the direct cost of diabetes to the health care sector is about US$ 16.94 billion and accounted for 6% of total health budget in 1998. It is clear that people with diabetes consume a greater proportion of health care costs than people without diabetes. This is primarily due to the cost of complications but includes the ongoing requirement for medications, supplies, laboratory assessments, and relatively frequent visits to health professionals.

The prediction that the greatest rise in the number of people in developing countries will occur in the productive years between 20-64 has substantial implications for the WPR with regard to indirect costs as well the increased demands on health services.


Social Impact of Diabetes
The impact of early mortality and morbidity from diabetes on productivity and financial and social cost to the community are immense. The role and position of men as providers of family resources and women as family carers can be severely affected by diabetes complications. Public provision on disability and palliative care is non-existent in many developing countries causing additional financial physical and emotional strain on families, particularly the women.

Personal Impact of Diabetes
For the individual, the impact of a diagnosis of diabetes has substantial social and lifestyle implications including the planning and timing of meals, frequent self-measurement of blood glucose, the administration of insulin or oral medications, adjustments and precautions for physical activity, and avoidance of short term complications such as hypoglycaemic episodes.Quality of life and personal confidence are inevitably compromised.

If not halted, the epidemic increases in the incidence of diabetes over the next decade or two will render even the best resourced health systems unable to meet future demands unless primary and secondary prevention measures are systematically and promptly applied.

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