Diabetes has been on the rise since the beginning of the new millennium. 80% of people with diabetes come from low and middle income countries. Experts assume that there are almost 8 million diabetics in Germany alone. According to projections, the number of diabetics worldwide (starting from 2011) will increase from 366 million to 552 million by the year 2030. At about 90 percent, most sufferers have type 2 diabetes. It occurs in contrast to the type 1 diabetes from the 40th, but especially after the age of 60 years and was therefore earlier referred to as "adult onset". Due to a lack of exercise and an unbalanced diet, this type of diabetes is on the rise even among children today. Overall, more women (7.36 percent) than men (6.45 percent) are affected by the disease.
Top 10 of the "diabetes countries"
People with diabetes from 20 to 79 years in 2011 worldwide:
|1. China||90.0 million|
|2. India||61.3 million|
|3. USA||23.7 million|
|4. Russia||12.6 million|
|5. Brazil||12.4 million|
|6. Japan||10.7 million|
|7. Mexico||10.3 million|
|8. Bangladesh||8.4 million|
|9. Egypt||7.3 million|
|10. Indonesia||7.3 million|
Source: "Diabetes Atlas Second Edition Executive Summary", IDF 2012 (World Diabetes Association)
Consequential damages of diabetes mellitus
A poorly adjusted blood sugar value can lead to the following damage to large and small blood vessels, the so-called macro- and microangiopathic sequelae:
- Diabetic retinopathy: This is damage to the retina (retina) in the background of the eyeball. Affected are the small blood vessels of the retina, because glucose (glucose) and other sugars are deposited on the vessel walls. This will reduce adequate blood flow to the retina. Diabetic retinopathy is the most common cause of blindness in people between the ages of 20 and 65 in Europe and the United States. In Germany, a diabetic goes blind every 90 minutes.
- Neuropathy: Diabetes can attack the nerves in two ways: indirectly via decreased blood supply and directly as a result of high blood sugar levels. As a result of the increased blood sugar levels, the blood vessels stick together, which supply the nerves in the arms and legs with blood, leading to circulatory disorders of the nerve fibers. As a result, the nerve is not supplied with sufficient oxygen. This leads to short-circuit reactions that damage the nerves.
- Renal failure: The kidneys are damaged by diabetic microangiopathy and the associated circulatory disorders. This kidney damage can lead to chronic kidney failure. In this case, a regular artificial blood washing (= dialysis) is necessary. In addition, damage to the kidneys causes high blood pressure, which usually requires medication.
- Diabetic foot: The reduced blood flow and the damage to the nerves, associated with sensory disturbances in the feet, lead to open, poorly healing wounds and ulcers, which may still require amputations today. Preventive measures and appropriate education of the patient about the proper foot care (regular washing of the feet with lukewarm soapy water and thorough drying, avoidance of injuries during the pedicure) and the appropriate footwear are absolutely essential.
- Other consequential damages: Diabetes mellitus also causes changes in the large blood vessels (= diabetic macroangiopathy). This is atherosclerosis. Especially in combination with high blood lipids, high blood pressure, obesity and nicotine consumption, chronically elevated blood glucose levels are a major risk factor for heart attacks and strokes. Other serious consequences of diabetes mellitus may be disorders of libido and erection problems.
Therapy of diabetes mellitus
Since type 1 diabetics lack insulin production, they need to take insulin from the beginning. Type 2 diabetes is first treated with a lifestyle change according to the guidelines of the German Diabetes Association. This provides above all a diet and more exercise. A diabetes-friendly diet includes the intake of all essential nutrients, low-fat, high-carbohydrate and high-fiber foods, as well as the maintenance or achievement of the ideal weight or the reduction of obesity in type 2 diabetes.
If these measures are not enough, the therapy starts with different active ingredients, which are taken in tablet form. These are so-called oral hypoglycemic agents, which in part have a favorable influence on the weight reduction and enable a flexible diet.
If these drugs are no longer able to ensure that the blood glucose levels are as normal as possible, therapy with insulin should be started as soon as possible. Currently about 1.4 million diabetics in Germany inject insulin.
Cost of Diabetes Mellitus
Until the diagnosis of diabetes often pass many years in which the blood sugar is usually too high and thus already the first fine vessels and nerves are damaged. Precisely against the background of the ailing healthcare system, prevention is becoming increasingly important. Because, as the CODE-2 study showed, the total costs for type 2 diabetics in Germany are higher than previously thought.
In 1998, they amounted to 16.1 billion euros. The statutory health insurance companies alone spent 9.5 billion euros on the treatment of these patients. Half of the health insurance costs were for inpatient, 13 percent for outpatient treatment. The cost of direct diabetes medication (insulin, oral antidiabetics) is just seven percent of the total cost. As soon as a patient becomes ill with the long-term effects of diabetes, the expenditure quadruples in comparison to an average statutory health insurance.
Seven percent of the health insurance costs alone are due to incapacity for work. In addition, every tenth type 2 diabetic early retiree, which, according to the CODE-2 study per patient indirect, additional costs of 688 euros a month arise. The cost and not least the suffering of the patients could be significantly reduced if the control of the diagnosed diabetes is considerably intensified.
The high concomitant and consequential morbidity of diabetes is associated with high costs. Currently, these amount to about ten percent of the current expenditure of the German health system. This corresponds to an amount of approx. 30 billion euros.
- Outpatient care of patients with diabetes mellitus in 2001, H. Hauner et a /., German Medical Weekly 128, 2638-2643, 2003
- German Health Report Diabetes 2004. Published: German Diabetes Association, Verlag Kirchheim + Co GmbH
- Diabetology in Clinic and Practice, Hellmut Mehnert, Eberhard Standl, Klaus-Henning Usadei, Hans-U! Rich Haring, Georg Thieme Verlag, 5th edition, 2004
- Global burden of diabetes, 1995-2025, H. King et al., Diabetes Care, 21, 1414-1431, 1998, Cost of Type 2 Diabetes in Germany - Results of CODE-2 Study, A. Lieb! et a / "German Medical Weekly Journal, 126, 585-589, 2001
- "Diabetes Atlas Second Edition Executive Summary", IDF 2012 (World Diabetes Association)