Health: Diabetes

Baroness Manzoor Excerpts

Thursday 2nd July 2015 Lords Chamber

[Baroness Manzoor (LD)]

I congratulate the noble Lord, Lord Harrison, on securing this debate and on his insightful and well-informed views on the issues of diabetes. Like many in your Lordships’ House, I am familiar with the effects of diabetes as, unfortunately, a family member has a history of it. I therefore declare my personal interest in the disease.

Looking at the range of speakers in today’s debate, I am sure that diabetes in the UK will be covered very well. As I have recently taken on the brief of spokesperson on international aid and development, I thought that I would take an international perspective on the disease, which I hope will not throw the Minister off his stride. It is certainly not my intention to do that.

The next big issue in diabetes internationally will be TB-diabetes co-infection. However, before I move on to that area, I want to restate that our NHS spends about £10 billion on diabetes every year, equal to 10% of its entire budget. This is an important disease to research, diagnose and treat effectively in the UK. It should also be a priority to ensure that any variations in treatment—the noble Lord, Lord Harrison, alluded to this—are minimised across the population, particularly as there are currently 3.9 million people living with diabetes in the UK.

The International Diabetes Federation estimates that, worldwide, there are 387 million people living with the disease, equal to 8.3% of the global population. It also estimates that, by 2035, an additional 205 million people will develop diabetes. The World Health Organization estimates that in 2012 diabetes was the direct cause of 1.5 million deaths and projects that diabetes will be the seventh leading cause of death by 2030. The total number of deaths from diabetes is projected to rise by more than 50% in the next 10 years globally. These figures are scary—even more so when you consider that 80% of diabetes deaths occur in low and middle-income countries, many of which may already be ravaged with disadvantage, poverty and conflict.

We in the UK should take a lead in increasing global awareness of this disease through our meetings with the UN and the EU, so that sufficient resources are made available to address this epidemic. As has been seen in the UK, diabetes care is costly and has the potential to cripple any healthcare system. According to the International Diabetes Federation, $1 in every $9 spent on healthcare is currently spent on diabetes.

It is interesting to note that type 2 diabetes used to be seen as a disease of the rich world and that, when it started to affect the better-off in poor countries, it was perceived as a sign of development. Now, three out of four people with diabetes live in low and middle-income countries. This rise in type 2 diabetes is being driven by ageing populations, rapid urbanisation and lifestyle changes. In developed countries, most people with type 2 diabetes are above the age of retirement, whereas in developing countries those most frequently affected are aged between 35 and 64. This means that in low and middle-income countries, type 2 diabetes affects many more people of working age, which has a profound effect on economic productivity.

Of course, type 2 diabetes treatment and care are not yet routinely or widely available in developing countries and, when treatment is available, it is rarely free. For individuals in developing countries, the out-of-pocket costs to treat type 2 diabetes are very high, often leading households to sell their possessions to pay for their treatment. In India, for example, treatment costs for an individual with diabetes make up, on average, 15% to 20% of household earnings and many poor people often cannot afford to get treatment or cannot access it easily.

At a national level, the type 2 diabetes epidemic threatens to overwhelm health systems and, potentially, to reverse development gains made in low-income countries—countries where we are spending a lot of money. Therefore, through DfID, more targeted investment is needed to support fragile health systems and stretched national healthcare budgets and to prevent economic progress from being undermined.

However, there is yet another threat. Low to middle-income countries now face a double burden of disease: rates of non-communicable diseases, such as type 2 diabetes, heart disease and stroke, are on the rise, but at the same time low to middle-income countries are still grappling with high burdens of infectious diseases, such as TB, HIV/AIDS and malaria.

In TB-diabetes co-infection, high blood sugar levels suppress the immune system, making individuals with latent TB—someone who does not have symptoms, is not sick and cannot spread the disease to others—more at risk of developing active TB. This is similar to how HIV undermines the immune system and makes individuals living with the virus more susceptible to developing TB. People with type 2 diabetes are three times more likely to develop TB, and type 2 diabetes is responsible for causing an estimated 15% of all TB cases. Brazil, China, Indonesia, Pakistan, India and Nigeria together account for 52% of people living with TB and 50% of all people living with diabetes. This is important for the UK, because of the strong ties that we have with these countries, and we must also not forget the fact that some parts of London have the highest incidence of TB in Europe.

What we are seeing happen now with TB-diabetes is similar to what we saw happen with TB-HIV. When HIV rates rose in the early 1990s, with the immune systems of people with HIV being weakened, that caused TB rates to skyrocket, particularly in Africa. We must make sure that history does not repeat itself by tackling TB-diabetes head on. Failing to act could lead to significant increases in avoidable disability and early death and could have disastrous consequences for health systems. There needs to be more integration between TB and diabetes programmes, similar to how it has been essential to integrate TB and HIV programmes. Perhaps the Minister could reassure us that NHS England in the UK has collaborative frameworks in place to enable this to happen. Could the Minister also reassure me that the Department of Health works collaboratively with DfID to develop policies on TB-diabetes and could he say whether those policies enable more co-ordination between programmes and countries with a high burden of TB and escalating rates of diabetes?

Finally, I know that preventing diabetes and promoting the best possible care for people with diabetes are a key priority for our Government, which is to be welcomed. However, not only does more need to be done to educate our own population about type 1 and type 2 diabetes, but we must also ensure through our aid programme that this epidemic is not forgotten. We are world leaders in providing excellent health services and we have a significant and well-developed research base. That puts us in a strong place to provide a global leadership role and we should embrace that in this key area.