Sunday, 14 November 2021, was the World Diabetes Day. The International Diabetes Federation (IDF) has set the theme for World Diabetes Day 2021-23 as: “access to diabetes care.” The IDF is an umbrella organization of over 240 national diabetes associations in 168 countries and territories. 

Despite COVID-19, diabetes on its own is currently a pandemic of unprecedented magnitude. Nearly 7 million adults have died worldwide in 2021 so far due to diabetes or its complications, more than 1 in 10 global deaths from any cause. There is more focus on access to care, especially insulin, 100 years since its discovery.

One hundred years after the discovery of insulin, millions of people with diabetes worldwide cannot access the care they need. People with diabetes require ongoing maintenance and support to manage their condition and avoid complications. The advent of the COVID-19 pandemic has added more challenges to persons living with diabetes. Such persons are more vulnerable to the severe complications of COVID-19. The resources required for diabetes care may be used for the COVID-19 pandemic putting care for diabetes under more strain. COVID-19 has disrupted access to care, screening, and diagnosis, potentially leading to severe complications over the longer term. The burden associated with the lockdown measures imposed in many countries has constrained people’s ability to exercise and/or eat healthily and caused psychological distress.

2021, which marks the centenary of the discovery of insulin, presents a unique opportunity to bring about meaningful change for the more than 460 million people living with diabetes and the millions more at risk. There is a need for more investment in diabetes care and prevention to ensure that everyone living with diabetes can access the care they need. 

The statistics from the IDF are grim: 463 million adults (1-in-11) were living with diabetes in 2019. By 2024, the IDF expects the figure to rise to 1 in 8 adults. The number of people living with diabetes will increase to about 578 million by 2030. More than 3 in 4 people with diabetes live in low and middle-income countries. In pregnancy, 1 in 6 live births (20 million) is affected by high blood glucose (hyperglycaemia). Two-thirds of people with diabetes live in urban areas, and three-quarters are of working age. 1 in 5 people with diabetes (136 million) is above 65 years old. Diabetes caused 4.2 million deaths in 2019. 

Diabetes was responsible for at least $760 billion in health expenditure in 2019, about 10% of the global total spent on healthcare. 1 in 2 adults with diabetes remains undiagnosed(232 million). The majority have type 2 diabetes. Tens of thousands of people with type 1 diabetes need insulin to survive. More than 30 million with type 2 diabetes who require insulin do not have access to a reliable and affordable supply. In Africa, 86% of people with type 2 diabetes cannot access the insulin they need. 63% of households in low-income countries cannot afford insulin, along with 2.8% of households in high-income countries.

Ghana is one of the 48 countries of the IDF African region. Four hundred sixty-three million people have diabetes globally and more than 19 million people in the African Region; by 2045, it will be around 47 million. The total adult population in Ghana is 15, 452, 100. The prevalence of diabetes in adults is about 1.8%. The total number of cases of diabetes in adults is about 281,000. 

The IDF has lined up some measures required to address the diabetes burden. These include, greater access to diabetes care, diabetes education in schools, online tools for people to learn about their potential risk of type 2 diabetes, and organization of diabetes awareness walk at the local or community levels. Others are to light up a local landmark, home, workplace in blue, arrange an activity with work colleagues. Regular physical activity is an essential part of diabetes management and reducing the risk of type 2 diabetes. Whether indoors or outdoors, every step counts to help stay healthy! Use blue colors to support the #WorldDiabetes Day.

A century aft­er the discovery of insulin, it is essential to remember that this and other fundamental components of diabetes care continue to remain beyond the reach of many who need them. Despite all the progress in diabetes care over the last 100 years, diabetes remains one of the most critical health challenges our societies face today. The World Health Organization Global Diabetes Compact and 2021 Resolution call for urgent, coordinated global action to tackle diabetes.

Type 2 diabetes mellitus (T2DM) is the most common form of diabetes and accounts for about 90% of all diabetes cases. T2DM is a condition of high blood glucose caused by inadequate insulin secretion and or insulin resistance. Control of blood glucose in such persons is a combination of medications and changes in lifestyle such as, physical exercise and nutrition.

Dietary components have assumed importance in the management of diabetes. Flavonoids are natural dietary compounds abundant in fruits and vegetables. The European Prospective Investigation into Cancer and Nutrition-InterAct (EPIC-InterAct) case-cohort study, including 340,234 participants, with 3.99 million person-years of follow-up in eight European countries, showed that a higher intake of flavanols was associated with a significantly reduced hazard of diabetes.

The Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPPIE) study with 5806 participants during four years also concluded that intake of flavanols was associated with a significant decreased risk of T2DM. In a major epidemiological study in US, men and women recruited from the Nurses’ Health Studies (NHS and NHS II) and Health Professionals Follow-Up Study (HPFS) and during a 3,645,585 person-years of follow-up, the reduced risk of T2DM was associated with higher consumption of anthocyanins.

Cocoa is an excellent source of flavanols. Consumption of flavanol-rich cocoa enhances insulin secretion, improves insulin sensitivity, exerts a lipid-lowering effect, and prevents oxidative and inflammatory damages associated with diabetes (Ramos et al. Effects of Cocoa Antioxidants in Type 2 Diabetes Mellitus Antioxidants 2017, 6, 84).

As we mark World Diabetes Day, it is vital to use the occasion to consider flavanol-rich cocoa as an adjuvant in the management of diabetes mellitus.

By Dr. Edward O. Amporful

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