Europe eating itself poorer with rising diabetes costs, data, health-tech could reverse trend [Advocacy Lab Content]

“When the people shall have nothing more to eat, they will eat the rich,” said Jean-Jacques Rousseau – he didn’t have diabetes in mind. European cuisine has come a long way since the French Revolution, and sure, we have more on our plates, but Europeans are eating themselves into an early grave.

Europe’s food landscape is undergoing a significant transformation, a surge in the availability of shelf-stable, high-calorie products, coupled with limited access to healthier alternatives due to financial and demographic constraints, is driving an alarming rise in high Body Mass Index (BMI) cases.

Our consumption of ultra-processed foods, fats, sugars, and animal products has seen a marked increase, matched with a steady decline in physical activity levels – largely linked to changing work and transportation patterns.

These trends are particularly pronounced in low-income and middle-income populations, where the transition from traditional diets to industrialised ones has been swift and stark. This abrupt pivot has seen a significant surge in nutrition-related non-communicable diseases, including type 2 diabetes.

Common risk factors

A European Commission official acknowledged to Euractiv that “Diabetes continues to be prevalent in the EU,” but emphasised, “We have however made a lot of progress in the comprehensive approach to non-communicable diseases, which targets common risk factors for diseases such as diabetes and cardiovascular disease.”

The official added that “Under the ‘Healthier Together’ initiative, we have made an unprecedented amount of funding available to support joint actions on diabetes and other non-communicable diseases.”

While this is true, the European Commission has its hands tied on directly implementing health policy – health remains a national remit. Brussels can do little more than nudge and incentivise, providing a coordinating and benchmarking structure while leveraging EU funds to support broader health initiatives.

Given the deep and increasingly serious impact of diabetes on Europe’s economy, the prospect of a European Health Union is not just a pathway to better health, but a stronger more productive economy, less wracked and drained by disease.

Early intervention strategies

Immediate action in the form of early intervention strategies, such as patient education, regular health check-ups, and pharmacological approaches, presents a potential near-term solution.

These strategies, complemented by lifestyle changes, can provide clinicians, public health professionals, and policymakers with effective tools to combat this soaring health crisis.

Studies conducted in Finland, China, and the USA suggest that early interventions can prevent, or at least delay, the onset of type 2 diabetes. However, the challenge lies in the implementation. Few countries have healthcare systems that are equipped to take a proactive approach or have the infrastructure to prioritise early interventions.

The development and implementation of strategies that can have a lasting impact at the population level remain a persistent challenge. The European and global community must address these issues to curb the rising tide of diet-related health concerns.

The rising cost of diabetes

Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation, and is on the rise, particularly in low- and middle-income countries. Between 2000 and 2019, diabetes mortality rates increased by 3%, causing an estimated 2 million deaths in 2019 alone.

This represents a substantial burden to healthcare systems, with estimates by the International Diabetes Federation (IDF) indicating that 537 million people worldwide had diabetes in 2021, resulting in health expenditures of US$966 billion globally, forecast to reach more than $1054 billion by 2045.

The main drivers of cost are hospital inpatient and outpatient care, but indirect costs accounted for 34.7% of the total burden, mostly due to production losses from labour-force dropout and premature mortality.

The increasing prevalence of type 2 diabetes is largely driven by the rising prevalence of obesity and physical inactivity. In 2019, only 40% of countries had an operational policy addressing overweight and obesity. Tobacco smokers are 30-40% more likely to develop type 2 diabetes than non-smokers – demonstrating why a holistic economic and health approach is needed.

National diabetes disease burdens

A leading diabetes study published in The Lancet identified regional and national diabetes disease burdens as part of a systemic analysis with projections of prevalence to 2050.

The report, produced by GBD 2021 Diabetes Collaborators notes that high BMI contributed to more than 60% of type 2 diabetes disability-adjusted life-years (DALYs) in central and eastern Europe.

High BMI contributed more than 60% of DALYs in 11 global regions including central and eastern Europe. By comparison, in South Asia, high BMI contributed less than 40% of type 2 diabetes DALYs.

Between 2021 and 2050, the global age-standardised total diabetes prevalence is expected to increase by 59·7%, resulting in 1.31 billion people living with diabetes in 2050, or an annualised rate of change of 3·31%.

Of this increase, 49·6% is driven by trends in obesity, and the remaining 50·4% is driven by demographic shifts.

Surveillance, prevention and intervention

The WHO Regional Office for Europe highlighted to Euractiv that the World Health Organization (WHO) has been working to stimulate and support the adoption of effective measures for the surveillance, prevention, and control of diabetes and its complications, particularly in low- and middle-income countries.

In April 2021, WHO launched the Global Diabetes Compact, a global initiative aiming for sustained improvements in diabetes prevention and care, asserting that data and technology can play a crucial role in managing the rising incidence and costs of diabetes.

The European Commission official told Euractiv that “Accurate population-level information on diabetes is limited. [However,] the Commission is working to improve access to such information through the CHIEF project (headed by JRC) and JACARDI project, the joint action headed by the Instituto Superiore di Sanità (Italy).”

“Through CHIEF, the Commission is developing the concept for a sustainable indicator collection framework for diabetes and is spearheading this initiative with the European network of diabetes registries (EU-BIROD).”

Data on diabetes derived from monitoring and surveillance systems in most countries are sparse and inadequate. Only 56% of countries worldwide have conducted a diabetes prevalence survey within the past five years.

To facilitate the harmonization and comparability of the burden of disease studies across Europe, the European Burden of Disease Network (EBoDN) has been established in collaboration with the WHO and IHME.

Transparent data needed

While 50% of countries globally, mostly high-income countries, report having diabetes registries, their predominantly hospital-based nature and limited coverage do not provide sufficient information on diabetes outcomes.

In this context, the WHO Secretariat, supported by an academic group, developed an approach to setting diabetes coverage targets based on a draft proposal. It recommends that five global diabetes coverage targets be established for achievement by 2030. Achieving these targets will contribute to the achievement of SDG target 3.4.

Based on this kind of data, modelling projections have demonstrated that achieving the target levels of diagnosis, treatment, and control of three targets (glycaemia, blood pressure, and statin use) of at least 60% results in a gain in median Disability-adjusted life years (DALY) of 38 per 1000 persons over 10 years – not just a massive benefit in public health, but economic gain.

Effective public policymaking to increase access to affordable medicines and health products requires the use of evidence derived from the accurate analysis of reliable and transparent data on prices and availability.

While Europe lacks this data, it cannot patch leaks in economic reserves as cash drains from public and private sector budgets servicing diabetes and its associated disease profiles. It’s time for Europe to curb its sugar high, and get fiscally fit and economically strong – we need a French Fries Revolution.

[By Brian Maguire | Euractiv’s Advocacy Lab ]

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