Disease burden of Diabetes

Disease burden

Disease burden is the severity and impact of a disease (1) which is measured by mortality, morbidity, clinical conditions,  quality of life, disability, years of life lost, and monetary cost  (2). In 2015 monetary cost of diabetes was estimated to be US$1.31 trillion which equals 1.8% cost of the global GDP (Gross Domestic Product) (3). Boomer and colleagues (2017), WHO (2016), Amon & Aikins (2017) classified costs differently. Considering all of the cost classification, author has created a combined classification of costs associated with diabetes (Figure 1).

Figure 1: Cost of diabetes (Source: Author’s construct)

Financial cost is one dimension of disease burden. Disease complication is another dimension of disease burden which requires attention. Diabetes complications include the risk of developing cardiovascular disease, retinopathy, end-stage renal disease (4),  and others (5-8).

However, considering the above discussion, it is evident, diabetes is associated with huge disease burden which has negative impact on the attainment of sustainable development goals (SDGs) (Figure 2). Sustainable development is the way of satisfying existing need without destroying the ability of the future generations to satisfy their own needs (9).

Figure 2: Sustainable Development Goals (Source: United Nations. The Sustainable Development Agenda 2016 .Available from: https://www.un.org/sustainabledevelopment/development-agenda/.)

Achieving sustainable development requires good health and well-being. Due to its immense disease burden and negative impact on health and well-being, diabetes is given priority by the world leaders as a part of achieving SDGs (4, 10).

Psychosocial Impact of Diabetes

Psychosocial impact is defined as the effect caused by environmental and/or biological factors on individual’s social and/or psychological aspects (11). Several studies found, diabetes has negative impact on a patient’s psychological aspects like mental health, quality of life, and social life (12, 13). Based on the literature review, author constructed a summarized figure of psychosocial impact of diabetes in Figure 3.

Figure 3: Psychosocial impact of diabetes (Source: Author’s construct)

To conclude this chapter, it is evident; diabetes is on the rise and present everywhere. The complication and associated disease burden of diabetes is huge. At this point question comes, what are the determining factors of the diabetes development. Next blog will answer this question.

Next …

Next blog will discuss on the determining factors of diabetes.


1.         Gidron Y. Disease Burden. In: Gellman MD, Turner JR, editors. Encyclopedia of Behavioral Medicine. New York, NY: Springer New York; 2013. p. 602-3.

2.         Prüss-Üstün AC, Carlos Preventing disease through healthy environments: Towards an estimate of the environmental burden of disease. World Health Organization; 2006.

3.         Bommer C, Heesemann E, Sagalova V, Manne-Goehler J, Atun R, Bärnighausen T, et al. The global economic burden of diabetes in adults aged 20–79 years: a cost-of-illness study. The Lancet Diabetes & Endocrinology. 2017;5(6):423-30.

4.         World Health Organization. Global report on diabetes. World Health Organization; 2016.

5.         Pinhas-Hamiel O, Zeitler P. Acute and chronic complications of type 2 diabetes mellitus in children and adolescents. The Lancet. 2007;369(9575):1823-31.

6.         Gregg EW, Li Y, Wang J, Rios Burrows N, Ali MK, Rolka D, et al. Changes in Diabetes-Related Complications in the United States, 1990–2010. New England Journal of Medicine. 2014;370(16):1514-23.

7.         Islam SMS, Alam DS, Wahiduzzaman M, Niessen LW, Froeschl G, Ferrari U, et al. Clinical characteristics and complications of patients with type 2 diabetes attending an urban hospital in Bangladesh. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2014;9(1):7-13.

8.         International Diabetes Federation. IDF Diabetes Atlas 8th Edition. International Diabetes Federation; 2017.

9.         United Nations. The Sustainable Development Agenda 2016 [Available from: https://www.un.org/sustainabledevelopment/development-agenda/.

10.       United Nations. Progress of Goal 3 in 2017 2017 [Available from: https://sustainabledevelopment.un.org/sdg3.

11.       de Oliveira AM, Buchain PC, Vizzotto ADB, Elkis H, Cordeiro Q. Psychosocial Impact. In: Gellman MD, Turner JR, editors. Encyclopedia of Behavioral Medicine. New York, NY: Springer New York; 2013. p. 1583-4.

12.       Ashraff S, Siddiqui MA, Carline TE. The Psychosocial Impact of Diabetes in Adolescents: A Review. Oman Medical Journal. 2013;28(3):159-62.

13.       Feng X, Astell-Burt T. Impact of a type 2 diabetes diagnosis on mental health, quality of life, and social contacts: a longitudinal study. BMJ Open Diabetes Research & Care. 2017;5(1).

Diabetes is increasing the risk of developing tuberculosis

A recent study over 2.3 million patients from 50 different countries concluded a 25% increase in diabetes prevalence would result in 8% increase of tuberculosis by 2035 (1).

Globally diabetes is increasing at an alarming rate in the low and middle income countries. Interestingly, a significant portion of diabetes patients remain undiagnosed. Among the patients who are diagnosed, very few of them take medications. A large number of diabetes patients, who are detected with having diabetes, has a very poor control on the disease (2).  

Hence, the new study indicates; undiagnosed and poorly controlled diabetes could therefore create an extra strain to tuberculosis care and prevention (3).

In The Lancet Global Health, Jean Jacques Noubiap and colleagues described, patients with active tuberculosis have a high burden of diabetes (4).

However, researchers have not confirmed; whether diabetes and tuberculosis has any cause and effect relationship. In other words, the study doesn’t suggest, whether tuberculosis led to the increase in diabetes or whether diabetes led to tuberculosis. What the study suggests; these two conditions are happening together (2)

The implication of the research is – urgent improvement is needed in screening and treatment of diabetes among the tuberculosis patients (2).



1.         Odone A, Houben RMGJ, White RG, Lönnroth K. The effect of diabetes and undernutrition trends on reaching 2035 global tuberculosis targets. The Lancet Diabetes & Endocrinology. 2014;2(9):754-64.

2.         Amberbir A. The challenge of worldwide tuberculosis control: and then came diabetes. The Lancet Global Health. 2019;7(4):e390-e1.

3.         Lönnroth K, Roglic G, Harries AD. Improving tuberculosis prevention and care through addressing the global diabetes epidemic: from evidence to policy and practice. The Lancet Diabetes & Endocrinology. 2014;2(9):730-9.

4.         Noubiap JJ, Nansseu JR, Nyaga UF, Nkeck JR, Endomba FT, Kaze AD, et al. Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2·3 million patients with tuberculosis. The Lancet Global Health. 2019;7(4):e448-e60.

Symptoms of Diabetes

Diabetes is a chronic, progressive disease characterized by elevated levels of blood glucose. Diabetes of all types can lead to complications in many parts of the body and can increase the overall risk of dying prematurely (1).

Diabetes is a serious, chronic disease that occurs either when the pancreas does not produce enough insulin (a hormone that regulates blood glucose), or when the body cannot effectively use the insulin it produces. Raised blood glucose, a common effect of uncontrolled diabetes, may, over time, lead to serious damage to the heart, blood vessels, eyes, kidneys and nerves. More than 400 million people live with diabetes (1).

As discussed previously, diabetes is broadly classified into two categories; type 1 and type 2. Symptoms of both types are usually similar with slight differences. 

Figure 1: Common symptoms of diabetes

Type 1 

Type 1 diabetes is characterized by deficient insulin production in the body. People with type 1 diabetes require daily administration of insulin to regulate the amount of glucose in their blood. If they do not have access to insulin, they cannot survive (1). Common symptoms include (Figure2) (2) :

Figure 2: Symptoms of Type 1 Diabetes

Type 2 

Type 2 diabetes is the most common type of diabetes which accounts for 90% of all cases of diabetes. It results from the body’s ineffective use of insulin. Symptoms may be similar to those of type 1 diabetes but are often less marked or absent. As a result, the disease may go undiagnosed for several years, until complications have already arisen. For many years type 2 diabetes was seen only in adults, but it has begun to occur in children (1). Common symptoms of type-2 diabetes include (Figure 3) (2):

Figure 3: Symptoms of Type 2 Diabetes

Next …

In the next blog you will know the prevalence of diabetes.


1.         World Health Organization. Global report on diabetes. World Health Organization; 2016.

2.         International Diabetes Federation. IDF Diabetes Atlas 8th Edition. International Diabetes Federation; 2017.

Definition of diabetes


Diabetes is not a single disease (1). It is a set of diseases characterized by elevated plasma glucose level (1) due to insufficient insulin production (2). A simplified definition of diabetes can be, diabetes is a disease when body can’t produce enough insulin. From clinical perspective, diabetes mellitus is defined as a metabolic disorder which has multiple aetiology, resulted from insufficient insulin production, defect in insulin action, or both, and is characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein (2).

Aetiologically diabetes is classified in the following ways [Figure1] (3).

Figure 1 : Aetiological classification of diabetes

Diabetes is not a modern phenomenon.

In fact, a very similar condition was described centuries ago by the ancient Romans, Indians, Arabs, and the Greeks. In India, it was called Madhumeha, meaning honey urine. While in Greece, they named it Siphon, which is a reference to increased urination, still an important sign of diabetes today.

Diabetes is a complex disease which affects multiple organs in our body. Today it is diagnosed by way of a blood glucose test, or by an oral glucose tolerance test.

Simply put, diabetes is a term used to describe the body’s inability to produce sufficient amounts of insulin. Insulin is a pancreatic hormone, and functions as a main glucose regulator. It communicates with our liver as well as our muscle and adipose tissue, or in other words, the nervous system and the gastrointestinal tract, to make sure that our glucose levels are balanced because both high and low blood glucose levels are dangerous.

Next …

In the next blog you will know about the symptoms of diabetes.


  1. Dennedy MC, Rizza RA, Dinnen SF. Classification and Diagnosis of Diabetes Mellitus. Endocrinology: Adult and Pediatric. 7 ed: Elsevier Inc.; 2016.
  2. Alberti KGMM, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation. Diabetic Medicine. 1998;15(7):539-53.
  3. Frier BM, Fisher M. Diabetes Mellitus. In: Colledge NR, Walker BR, Ralston SH, Davidson S, editors. Davidson’s principles and practice of medicine. 21st ed. / the editors, Nicki R. Colledge, Brian R. Walker, Stuart H. Ralston ; illustrated by Robert Britton. ed. Edinburgh ;: Churchill Livingstone/Elsevier; 2010. p. 795-840.


Diabetes is a group of metabolic diseases (1). Over the last three decades, globally diabetes is growing at a steady rate (2). The increasing prevalence of this disease is imposing huge disease burdens on individual, social and global level (2,3). This indicates, for a sustainable development, diabetes requires attention.


The objectives of this blog series are to define the disease, assess its burden (globally and in Bangladesh), measure its public health significance, identify the broad determinants of the disease, and critically review its management framework.


Diabetes is on the rise, everywhere (2) and it has been increasing from 180 million in 1980 to 422 million in 2014 (4). It is a leading cause of blindness (5), kidney failure, heart disease, lower limb amputation and stroke (2). Estimate suggests, by 2040 the number of diabetes patients will increase to 642 million (3). It means,1 in 10 adults will be living with diabetes by 2040. Considering the high prevalence, growth, and disease burden, diabetes is selected for this work.

Next …

In the next blog you will know about what diabetes is.


  1. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2009;32(Suppl 1):S62-S7.
  2. World Health Organization. Global report on diabetes. World Health Organization; 2016.
  3. International Diabetes Federation. IDF Diabetes Atlas 8th Edition. International Diabetes Federation; 2017.
  4. Mathers CD, Loncar D. Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLOS Medicine. 2006;3(11):e442.
  5. Bourne RR, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, et al. Causes of vision loss worldwide, 1990-2010: a systematic analysis. The Lancet Global health. 2013;1(6):e339-49.