Nearly 540 million adults in the world live with diabetes and, by 2030, this number is estimated to increase to 643 million (783 by 2045). These are data from the International Diabetes Federation (IDF), which warns that one in nine adults in the world has diabetes, and that 230 million people live with the disease without being diagnosed. The World Health Organization considers similar figures, and looks back to understand the evolution of the prevalence of diabetes, which went from 108 million people in 1980 to 422 in 2014.
In Europe, estimates from the 10th Edition of the IDF Diabetes Atlas suggest that one in eleven adults (61 million) lives with diabetes, and that some 22 million are undiagnosed. Among the countries on the continent, Spain is one of those that registers one of the highest average prevalence, 14.8% compared to 9.2% globally, which places it above other countries such as Portugal (13%) or Italy (9.9%). “In fact, it is the second country in Europe with the highest number of people with diabetes, only behind Germany,” point out the Spanish Diabetes Society (SED). The organization also points out that from the latest edition of the IDF Atltas it is extracted that there are about 5.1 million adults in Spain living with diabetes, which represents an increase of 42% since 2019, and that this is expected This figure continues to grow to 5.6 million in 2030 and 5.7 in 2040.
Furthermore, the disease affects one in seven adults in 2021 and almost a third (30.3%) of people living with diabetes in Spain were not diagnosed. The latest data from the national study di@bet.es, carried out in 2011 at the initiative of the Spanish Diabetes Federation and the Spanish Diabetes Society with the support of the Ministry of Health and Consumer Affairs, concluded that 13.8% of Spaniards People over 18 years of age had type 2 diabetes, which is equivalent to more than 5.3 million people. Of these, almost three million were diagnosed, while 2.3 million were unaware that they had the disease.
In Catalonia, the estimated number of people with diabetes exceeds 630,000 cases. According to the Catalan Health Survey 2022, the prevalence of the disease, which affects 9% of people over 15 years of age in Catalonia, has remained stable since 2011. Furthermore, the data show that the percentage of cases increases in older age groups, especially those aged 65 and older: 23.2% in the 65-74 age group and 22.8% in the 75 and older age group, compared to 1.8% in the 15-year-old group at 44 years old. Likewise, they point out, the disease increases among people from less favored social classes (11.4% compared to 4.6%), or among those with education or primary education compared to those with university studies (18% compared to 4.7%).
Diabetes is a chronic disease that occurs when the pancreas stops producing insulin or when the body cannot use it effectively. Insulin, a hormone made by the pancreas, plays a crucial role in functioning like a key. This key allows glucose, derived from the food we eat and circulating in our bloodstream, to access the body's cells, where it is converted into energy. Basically, insulin facilitates the passage of glucose into the cells. When the body is not able to produce or use insulin efficiently, high levels of glucose in the blood occur, which is known as hyperglycemia. In the long term, these high glucose levels are associated with damage to the body and can cause failure in various organs and tissues. Although there are three main types of diabetes, type 2 is the most common. Its main symptoms, points out the Spanish Society of Internal Medicine (SEMI), include “excessive thirst, increased urinary frequency, fatigue, blurred vision or involuntary weight loss. However, many people with type 2 diabetes do not have symptoms and the disease is discovered after the patient has suffered a medical problem such as elevated blood pressure, having suffered a myocardial infarction or a cerebral thrombosis.
In the case of type 1 diabetes, they point out on the Clínic Portal of the Cínic Hospital of Barcelona, the symptoms are so clear that all the people who have it know it. This type of diabetes represents between 5 and 10% of all cases, and usually begins in children and young adults, although less frequently it also develops in adults. Its cause is still unknown, and management of the disease requires lifelong insulin treatment. Patients “have to inject insulin to be able to live, perform capillary blood glucose tests before meals and follow a balanced eating plan,” the portal clarifies.
The high prevalence of diabetes, the progression of the disease throughout the world at increasingly younger ages and its derived complications lead, among other consequences, to an estimated global health expenditure of 966 billion dollars, which represents an increase of 316 % in the last 15 years. In Europe, the cost amounts to 189,000 million dollars, 20% of the global figure, and in Spain, 5,809 million euros. Data from the latest Diabetes Atlas report indicate that it is responsible for 12.2% of global deaths from all causes, which represents approximately 6.7 million deaths; and in Europe it represents 2% of the total deaths worldwide (111,000). In fact, according to WHO forecasts, by 2030, diabetes will be the seventh cause of death in the world.
The organization also warns that age-normalized diabetes mortality rates increased by 3% between 2000 and 2019, and in low- or middle-income countries, by 13%. Specifically, this condition was the direct cause of 1.5 million deaths in 2019 and, of all those who died from diabetes, 48% were under 70 years old. In addition, another 460,000 people died due to diabetic nephropathy, and hyperglycemia is responsible for around 20% of deaths due to cardiovascular causes, resulting in 2 million deaths in 2019 due to diabetes and diabetic nephropathy.
Given this situation, organizations such as the International Diabetes Federation or, at the state level, the Spanish Diabetes Society and its foundation emphasize the importance of fighting against underdiagnosis of the disease, promoting early diagnosis and ensuring quality education about this disease. ailment and its monitoring to achieve the objectives of glycemic control and other associated processes. Specifically, the SED urges that “diabetes screening be carried out, through a simple determination of blood glucose, in asymptomatic subjects of any age who are overweight or have other risk factors for developing diabetes; and, in subjects without these risk factors, screening is recommended from certain ages (between 35 and 45 years).”
Early diagnosis of diabetes is essential to be able to initiate adequate treatment and avoid long-term complications. The WHO establishes several methods to carry it out, depending on the clinical situation and risk factors of each individual. One of the most common ways is by measuring blood glucose levels, for which the following criteria have been defined:
• Fasting glucose greater than 126 mg/ dL: this method is used in asymptomatic people who have fasted for at least 8 hours, usually before breakfast. If the blood glucose concentration is equal to or greater than 126 mg/dL in two separate measurements, it is considered diabetes.
• Oral glucose tolerance test (OGTT): In this test, a solution containing 75 grams of glucose is administered, and the blood glucose concentration is measured two hours after administration. If the value is equal to or greater than 200 mg/dL, the diagnosis of diabetes is confirmed. This method is practically out of use today, except in the case of pregnancies.
• Hemoglobin A1c (HbA1c) greater than 6.5%: HbA1c is a measure that reflects average blood sugar control over the past two to three months. A value equal to or greater than 6.5% is considered a diagnosis of diabetes. This test is performed in a certified laboratory with a reference method. In any case, the diagnosis must be confirmed with repeated testing in an appropriate clinical setting. Furthermore, if a person presents typical symptoms of the disease, the presence of a blood glucose value greater than 200 mg/dL is sufficient to confirm this.
On the other hand, the appropriate time to perform diabetes diagnostic tests also varies depending on the clinical situation and risk factors. WHO recommends that asymptomatic people of any age who are overweight or obese and have additional risk factors, such as a family history of diabetes, undergo diagnostic testing
In the case of people without additional risk factors, a diagnostic test is recommended starting at 45 years of age and, if the results are normal, they should be repeated every three years. Early diagnosis of diabetes is essential to allow appropriate treatment and management of the disease. Once the diagnosis is confirmed, it is essential to work closely with a healthcare professional, such as a physician or endocrinologist, to establish a personalized treatment plan that may include changes in diet, exercise, medications, and regular monitoring of blood vessels. blood glucose levels.
