An estimated 32 million people in the European Union (8.1%) were living with diabetes in 2013. Although policymakers are now paying special attention to the issue and to obesity-related conditions more generally, health experts say more can be done to tackle what the EU considers as a chronic disease.

Overview

Every two minutes, an EU citizen dies of diabetes-related diseases, according to the European Diabetes Leadership Forum (EDLF), a stakeholder organisation initiated by pharma company Novo Nordisk, which aims to move diabetes up the public health agenda.

50% of all people with diabetes die of cardiovascular disease, making diabetes the fourth most common cause of death in Europe, EDLF figures show. Meanwhile, 10-20% die of kidney failure, 10% develop severe visual impairment and 50% suffer from diabetic neuropathy, it says.

However, governments are not whole-heartedly engaging in effective measures to curb obesity, according to the European Centre for International Political Economy (ECIPE), a think tank. This is despite calls from the World Health Organisation (WHO) and the Organisation for Economic Co-operation and Development (OECD) among others, to halt and revert obesity trends, which are driving diabetes.

In a policy document from 2013, the ECIPE says special attention should be paid to diabetes, which is considered a chronic disease linked to heart problems and strokes. Around 9.3% of the EU's total health budget is spent on diabetes.

Diabetes is caused by a lack of insulin, due to insufficient pancreatic production or high blood sugar levels. It can also develop from insulin resistance, a case where the pancreas produces insulin that is rejected by the body.

EU member states have been experimenting with measures to prevent obesity and excessive weight gain, which cause 'type 2' diabetes.

Such measures include those suggested by the OECD: food education and physical activity at school level, or food taxes targeting food products with high content of sugar or saturated fat.

“On current trends, and if no changes are made to the healthcare coverage, governments in Europe will soon be facing rapidly increasing costs related to the treatment of illnesses and health problems associated with obesity,” the ECIPE said.

Issues

The cost of diabetes

In March 2014, experts in Brussels called for the chronic disease curve to be broken, as it has not only great economic consequences, but also generates social inequality.

On top of the healthcare costs related to treatment, diabetes also creates many indirect costs for society due to lower productivity among the workforce, early retirement and payments of social benefits.

This is despite the fact that 'type 2' diabetes is, to a large extent, preventable. Risk factors for contracting the condition include excessive weight gain and obesity, an unhealthy diet, and lack of physical activity.

Speaking at a conference organised by the European Diabetes Leadership Forum, Health Commissioner Tonio Borg stressed the importance of prevention in fighting the disease. Experts say promoting and facilitating a healthy lifestyle can prevent or delay the onset of 'type 2' diabetes, for example among children, pregnant women and vulnerable groups.

HRH Prince Joachim of Denmark, who has been the patron of the Danish Diabetes Association since 1992, said that while the figures for diabetes are rapidly increasing, the burden is far greater than the numbers show.

"Diabetes also has a huge negative impact on families and social surroundings. We cannot allow this to continue," he said. "The cost of breaking the diabetes curve will be significant, but delaying will be much more expensive."

Laurette Onkelinx, Belgium's federal minister for Social Affairs and Public Health, added that complications related to diabetes can be quite disabling for some people as these may include blindness, kidney failure, and 5-10% of people with diabetes may lose a limb.

"Diabetes does require a multidisciplinary provision which is consistent and of high quality," the Belgian minister said.

Jerzy Gruhn, president of Europe at the pharmaceutical company Novo Nordisk, said that public-private partnerships could be one of the key solutions to make sure that healthcare systems are structured in a sustainable way. They will ensure that people with diabetes can have access to treatment now and in the future, he said.

His view was backed by Henrik Nedergaard, CEO of the Danish Diabetes Association, who said that with joint actions, European leadership and innovative partnerships, patients can have better lives.

"For me it goes without saying that patients come first. We must make sure that people with diabetes can live their lives to the full and we have a special obligation to make knowledge and best practice available and usable to all patients in Europe."

Prevention is key

Meanwhile, the French Diabetes Federation in June 2014 highlighted the 'silent nature of diabetes' as part of Diabetes Awareness Week.

"There are approximately 4 million diabetics in France and our estimations show that about 700,000 are not aware of their condition. Diabetes is a silent epidemic which is on the rise. If nothing is done in the next ten years, the number of French diabetics will increase to 8 million,” said the organisation.

A distinction must be made between 'type 1' and 'type 2' diabetes. Type 1 is a genetic condition predominantly affecting young people and is less common. Type 2 is can develop at any age and represents 90 to 95% of diabetes cases.

Type 2 diabetes often develops under the radar. Patients see a professional when the first serious complications emerge, at which point treatment will be late.

According to the Federation, type 2 diabetes affects 2.7 million people in France. "Diagnosing diabetes is often late, because it is a subtle disease. Initially, blood sugar levels and blood pressure increase slowly. It takes between 5 and 10 years before the first signs and diabetes can be diagnosed," said Patrick Henry, a Parisian cardiologist.

There are many health complications associated with type 2 diabetes, but the most worrying is the amplified risk of cardiovascular diseases. This is especially true if diabetics smoke, have high cholesterol, high blood pressure or are overweight.

"Heart attacks are a huge risk for diabetics. They are three or four times more at risk. The study shows that patients with type 2 diabetes have the same risk of heart disease as patients who have suffered from heart attacks," Henry stated.

Disease of the disadvantaged

The prime victims of 'type 2' diabetes are the less well-off. Henry describes it as the disease of the disadvantaged, because it mirrors societal differences across France.

"There is a North/South diabetes gradient. This might be because eating habits are worse in the northern regions compared to the Mediterranean lifestyle in the South of France, which is healthier for diabetics," said the cardiologist.

Prevention is central in order to limit the spread of diabetes. Taking greater control over the initial stages of diabetes would help deal with the epidemic.

"The tendency can be reversed during the initial phases of the disease, in the first ten years. After this period, it is no longer possible. Therefore, prevention is crucial," Henry told EurActiv.

Patient empowerment

Denmark’s Minister for Health, Nick Hækkerup, agreed with Henry, arguing that a lot of people throughout Europe will experience a lower quality of life if politicians do not act. The disease reflects social inequalities and tends to affect people from the lower-ranking social groups, the minister told EurActiv in an interview

Diabetes is a “serious challenge” for Europe's population that demands a stepped-up response from policy-makers, Hækkerup added, calling for more patient empowerment to fight diabetes.

"To a very large degree I think that one of the key tools in the coming years to fight diabetes is to empower the patient, to give the patient knowledge of the disease, to literally give the patient education in how to treat and handle the disease if you have gotten the disease. I think there is a lot to do when it comes to empowering people through enlightening them so that they can make the right decisions for themselves," Hækkerup said.

The other negative side effects

In an interview with EurActiv, Michael Larsen, professor of Clinical Ophthalmology at Glostrup Hospital and the National Eye Clinic in Denmark, said complications related to diabetes could also lead to blindness.

This is the most common source of blindness among workers, but something which can, for the most part, be prevented and treated.

But even though more people are being diagnosed with diabetes, there may not be a big increase in new cases of blindness in the EU, Larsen said, because prevention and the treatment of blindness are outpacing the increase in the number of people with diabetes.

“So even though we are seeing more people with diabetes, their treatment is becoming better which means they are also receiving better treatment for their eye complications related to the diabetes,” the professor said.

“If only we could make sure that diabetes patients would be offered treatment. Then we could avoid that people become blind from having diabetes. Maybe it would still weaken their sight, but in Iceland for example they have many doctors and almost no one becomes blind from diabetes-related complications,” Larsen added.

Positions

HRH Prince Joachim of Denmark, who has been the patron of the Danish Diabetes Association since 1992, told a Brussels conference in March 2014 that the burden from diabetes was far greater than even the rapidly increasing figures show.

"Diabetes also has a huge negative impact on families and social surroundings. We cannot allow this to continue," he said. "The cost of breaking the diabetes curve will be significant, but delaying will be much more expensive."

Laurette Onkelinx, Belgium's federal minister for Social Affairs and Public Health, added that complications related to diabetes can be quite disabling for some people as these can include blindness, kidney failure, and 5-10% of people with diabetes may lose a limb.

"Diabetes does require a multidisciplinary provision which is consistent and of high quality."

Henrik Nedergaard, CEO of the Danish Diabetes Association, commented:

"For me it goes without saying that patients come first. We must make sure that people with diabetes can live their lives to the full and we have a special obligation to make knowledge and best practice available and usable to all patients in Europe."

During Diabetes Awareness Week in June 2014, Patrick Henry, a Parisian cardiologist said:

"Diagnosing diabetes is often late, because it is a subtle disease. Initially, blood sugar levels and blood pressure increase slowly. It takes between 5 and 10 years before the first signs and diabetes can be diagnosed."

Danish Minister for Health, Nick Hækkerup, told EurActiv that diabetes patients needed to be empowered.

"To a very large degree I think that one of the key tools in the coming years to fight diabetes is to empower the patient, to give the patient knowledge of the disease, to literally give the patient education in how to treat and handle the disease if you have gotten the disease. I think there is a lot to do when it comes to empowering people through enlightening them so that they can make the right decisions for themselves."

Michael Larsen, professor of Clinical Ophthalmology at Glostrup Hospital and the National Eye Clinic in Denmark, added that diabetes often led to other health complications.

“If only we could make sure that diabetes patients would be offered treatment. Then we could avoid that people become blind from having diabetes. Maybe it would still weaken their sight, but in Iceland for example they have many doctors and almost no one becomes blind from diabetes-related complications.”

Timeline

  • Nov. 2013: EU's 2014-2020 health budget agreed
  • 3-4 Apr. 2014: EU health summit on chronic diseases
  • Apr. 2014: European congress on obesity 
  • 22-24 May 2014: World Health Assembly in Geneva
  • 30 Aug.-3 Sept. 2014: European Society for Cardiology congress in Barcelona
  • 17 Sept. 2014: Launch of the Diabetes Index 2014 in Vienna, Austria
  • 29 Sept. 2014: World Heart Day
  • 1-3 Oct. 2014: Gastein Health Forum in Austria
  • 29 Oct. 2014: World Stroke Day
  • 4-6 Nov. 2014: Conference in the European Parliament on cardiovascular disease