Type 2 Diabetes in the WorldDiabetes, especially Type 2 Diabetes is a global healthcare problem which increases substantially and causes large costs socially and economically.  It is considered by 2003 that there are 171 to 194 million diabetic patients in the world.  These numbers are expected to increase up to 330 million patients in 2025.  This increase means that the disease incidence will double within same generation.  Especially in parallel with this rapid increase experienced in Type 2 Diabetes, over weight, obesity in other words also increase rapidly.  Obesity is the most important risk factor for Type 2 Diabetes solely.  For today, approximately 150 million of slightly over-weighted, fat or obese individuals who do not have any health problem will have Type 2 Diabetes within next 10 years.   This close interaction of Type 2 Diabetes and Obesity has been defined as "Diabesity" by Ziv and Shafrir.

Social and economic problems caused by diabetes so severely have been ignored nationally and internationally for many years.  However, Type 2 Diabetes has become main target of many organizations mainly World Health Organization as a health problem which is difficult to deal with in terms of visual disorders and blindness, severe kidney failure progressing to dialysis, wounds due to nerve damage and severe cardiovascular diseases.

Type 2 Diabetes is among first five causes of deaths in the world.  Treatment costs of Type 2 Diabetes exceed billion dollars and cost for one year in USA only is over 132 billion dollars.

Type 2 Diabetes in Turkey

Type 2 Diabetes incidence in Turkey is known as 13.7% according to TURDEP II study.  According to this data, population of Type 2 Diabetes treated is predicted as 4,335,352 in 2010.

Total annual cost of Type 2 Diabetes with complications for Turkish healthcare system is predicted as 5,144 billion Euros.  Costs to treat diabetes complications constitute most of total costs and cardiovascular complications constitute 32.7% of total treatment cost.  Renal, ocular and neurological complications constitute 25.1%, 6.4% and 6.0% of total Diabetes costs, respectively.  While drugs represent 10.5% of expenses for Type 2 Diabetes annually, oral antidiabetic drug regimens (except insulin) constitutes 5.5% of total costs for Type 2 Diabetes and insulin based regimens constitutes 5.0%.  It is predicted that annual costs for drugs used to treat complications and accompanying diseases are 14.2% of total cost.  Ratio for annual screening directly is 4.5%.

Direct treatments costs of Type 2 Diabetes has increased with presence and progress of Type 2 Diabetes-associated chronic complications.  Hospitalization costs has created an important ratio and increased by presence and progress of Type 2 Diabetes-associated complications.  To reduce the effect on resources allocated for healthcare, effort should be made to prevent progress of complications of Type 2 Diabetes, to monitor complications and manage these better.

Treatment of Type 2 Diabetes and complications create a great financial load for healthcare system in Turkey.  Treatments costs for Type 2 Diabetes and its complications correspond to 1% of total Turkish economy (GDP).

• Complication costs are significant on cost for Type 2 Diabetes whereas drug costs constitutes a small part of total cost.
• These results are similar with CODE-2 study in Europe, however, costs of complications constitute a larger part of total cost in Turkey (71% versus 55%).
• Timely treatment of patients with Type 2 Diabetes will provide benefit for the patient and the healthcare system as a whole and reduced high cost complications.
• More researches are required on this field to strengthen accessibility of data and confirm these findings.

Resource: Evaluation of direct cost for Type 2 Diabetes and Its Complications in Turkey, 48th National Diabetes Congress, May 2012 Poster Presentation (P-1707) Simten Malhan1, Erhun Öksüz1, Zefi Vlachopioti2

1. Başkent University

2. Elly Lilly, Surrey, England

Becoming Widespread of Type 2 Diabetes

The most important diseases worldwide at the beginning of previous century were infectious microbial diseases.  These diseases has caused significant reduction on population due to holocaust especially in not-developed and undereducated societies.  Type 2 Diabetes was a very rare and generally not noticeable disease during that period.  In fact, ratio of developing societies in the world has increased in parallel with development of technology and communication.  The life period expected in these societies has become parallel with developed societies.  The life style, foods and habits in modern western communities has been adopted more.  As a result, old style or traditional lifestyle has been replaced with fast city life in many developing communities.  Individual action in traditional lifestyle was an obligation and a part of the life.   Foods consumed have consisted of natural foods which were grown by these people and do not include any additives.  In fact, movement in city life has been restricted almost to none because of transportation, computer and electronic entertainment.  A fast tempo has necessitated western style fast food habits.  These foods including excessive animal originated fats and carbohydrates have snowballed obesity because they are refined and away from naturalism.    Lack of physical activity and bad and unqualified nutrition has made diabesity (diabetes + obesity) as the most important healthcare problem.

This change in developing countries which is similar to western societies is called “Coca-Colonization” in the book of Arthur Koestler in The Call Girls book.

When increased lifetime and bad nutrition are combined, developing communities has faced with problems and costs caused by different non-infectious diseases, mainly Type 2 Diabetes.

Our genes have been modified according to the periods where we hunt and eat before hundreds-thousand, probably million years ago.  According to this theory (Thrifty Gene Theory) the body has been programmed to deposit each calorie taken in because of hunger for a long period.   Because we are a society which have less physical activity (in other words becomes lazy and slothful) and eat very fatty and full-calorie foods today, these genes continue to deposit excessive calories and cause us to be obese.

Childhood Obesity and Type 2 Diabetes in Children

As Type 2 Diabetes increases, incidence of Type 2 Diabetes during young ages, even during childhood also increases.  Typically, Type 2 Diabetes is seen during adulthood.  Since this information is still true, Type 2 Diabetes incidence gradually increases during 20s to 30s.  While the diabetes type seen during childhood is generally Type 1 A Diabetes, children with Type 2 Diabetes gradually increase in parallel with increase of obesity during childhood.  Moreover, 80% of pediatric diabetes consist of children with Type 2 Diabetes in Japan.  Diabetes is important and vital problem for children as well as adults.  Only 3% of pediatric diabetes patients were with Type 2 Diabetes until today whereas this ratio increases up to 45% in newly diagnosed diabetic patients.  As similar with adults, because our children move less because of computer games and television and spend time in a closed environment, this condition occurs. This case is called “Nintendo-nization”.

• Obesity and Type 2 Diabetes is a common disease group which affects all community from childhood.
• Obesity or overweight is a severe disease which should be treated.
• Morbid obesity is called as “fatal fatness” which is more likely to cause fatal health problems.
• Obesity is the most important disease causing Type 2 Diabetes.
• Obesity and Type 2 Diabetes causes many complications such as fatal heart attacks, paralysis, kidney disease progressing to dialysis, ulcerous wounds on feet and body etc.
• Obesity and Type 2 Diabetes which are called as Diabesity together cause severe diseases which affects your life comfort.
• The most efficient and permanent treatment of obesity causing Type 2 Diabetes is possible with metabolic Surgery.
• Metabolic Surgery fixes obesity -induced diabetes and almost all complications.   
• When operation is performed on early stages of findings and problems, achievement rate is higher.   
• Metabolic surgical methods are the only treatments to remove vital problems such as hypertension due to obesity and Type 2 Diabetes, hyperlipidemia (increase on blood fats).