Europe’s diabetes tsunami, a crisis in full view

Europe is spending more on diabetes in a year, than on the war in Ukraine. The diabetes tsunami is a public health crisis which threatens to overwhelm healthcare systems and economic progress.

Europe spent more on diabetes last year than all the EU funding donated to Ukraine since the Russian invasion. The prevalence of diabetes, particularly the largely preventable Type 2 diabetes, is rising at an alarming rate, driven by factors such as obesity, and an ageing population. The annual cost of diabetes in Europe is limiting European economic growth.

In 2021, diabetes-related expenditure in Europe totalled approximately €170 billion, accounting for 19.6% of global diabetes expenditure. The average annual cost per person with diabetes in Europe was around €2,760.

By contrast, Europe has committed €150 billion in financial, military, humanitarian, and refugee assistance, including funds allocated until 2027 through the European Peace Facility.

Diabetes prevalence in Europe

Spain recorded the highest diabetes prevalence in Europe in 2021, with nearly 15% of adults diagnosed, followed by Portugal at around 13%.

Most European nations reported diabetes prevalence rates of approximately 8-9%. Czechia had the highest diabetes-related mortality in 2021, with 43.4 deaths per 100,000 population, and mortality rates were notably higher among men than women across Europe.

An Irish Department of Health spokesperson told Euractiv: “The diabetes tsunami in Europe is a pressing public health challenge that demands immediate and coordinated action.”

However, they added that “With the right policies and interventions, it is possible to mitigate the impact of diabetes and improve the quality of life for millions of Europeans.”

Burdening the economy

The economic burden of diabetes on European healthcare systems is substantial, yet universal healthcare systems prevent these costs from being passed onto patients. In 2021, Switzerland spent nearly €11,600 per person with diabetes, while the UK, France, and Germany spent between €5,200 and €6,000 per person annually.

Germany had the highest hospital admission rates due to diabetes, at 172 per 100,000 inhabitants, and Romania and Czechia reported over 18 lower extremity amputations per 100,000 diabetes patients.

Global surge, diet to blame

The global prevalence of diabetes is projected to surge, reaching 12.2% of the population by 2045. While type 1 diabetes remains unpreventable, 95% of diabetes cases are type 2, influenced by age, poor diet, and sedentary lifestyles.

In 2021, over 30% of the population in more than half of European countries exhibited insufficient physical activity, with soft drink consumption – an obesity risk factor - averaging 98 litres per capita in 2022.

Diabetes is one of the most common chronic conditions in the WHO European Region, with Europe having the highest burden of Type 1 diabetes globally.

It is estimated that 1 in 10 people in the region will have diabetes by 2045. The number of adults living with diabetes in Europe is projected to increase from 32 million today to 35 million by 2030.

Economic Impact

These costs include direct medical expenses such as hospitalizations, medications, and outpatient care, as well as indirect costs related to lost productivity and premature mortality.

In France alone, the total direct medical costs of Type 2 diabetes are estimated at €29 billion annually.

Diabetes affects 4 million French people today, a figure that has increased sixfold in just 30 years. 90% of French diabetics have type 2 diabetes, and nearly 700,000 people with diabetes remain unaware of it.

France ranks 26th out of 189 countries for its Human Development Index (HDI), and with diabetes also striking the most socially vulnerable, prevalence rates are much higher in the most disadvantaged cities.

French diabetes prevalence is currently 5.4 %, with 1 in 2 French people now overweight and 15% struggling with obesity. In France the cost of diabetes is €19 billion per year, representing 15 % of health spending.

Europe’s policy response

Recognizing the urgent need to address this crisis, the European Parliament adopted a motion for resolution on the prevention, management, and better care of diabetes in the EU in November 2022.

This resolution called for Member States to develop and implement national diabetes plans, ensure equitable access to treatments, and promote diabetes education. The resolution also emphasizes the need for stronger EU leadership and collaboration with Member States to achieve these goals.

The “Blueprint for Action on Diabetes in the European Union by 2030” outlines several key priorities and recommendations, including risk reduction, integrated care, enabling access to quality care and engaging people with diabetes.

Early diagnosis, effective management

Ireland’s Department of Health told Euractiv: “The European Union’s recent policy initiatives and WHO’s recommendations provide a solid foundation for tackling this crisis. However, sustained effort and collaboration at all levels are essential to turn the tide against diabetes and ensure a healthier future for Europe.”

The World Health Organization (WHO) emphasizes the importance of early diagnosis and effective management to prevent complications and has been actively involved in addressing the diabetes crisis in Europe.

According to the WHO, diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation.

The WHO’s “Declaration on Accelerating Action on Commitments to Improve Diabetes Detection and Quality of Care” highlights the need for integrated and people-centred approaches to diabetes management. This includes promoting diabetic retinopathy screening and improving access to essential medicines and technologies.

National initiatives

As a consequence of EU and WHO initiatives, several European countries have implemented national diabetes plans to combat the rising tide of diabetes, including Slovenia which has developed a comprehensive 10-year program on diabetes, focusing on prevention, early detection, and integrated care. Latvia also aims to improve access to diabetes medicines in line with WHO recommendations.

In Rome last November, a new four-year project called the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI) was launched. The initiative aims to engage ministries, public health bodies, non-governmental organizations, and universities, to assist European Union (EU) member states in reducing the burden of cardiovascular diseases (CVD), diabetes, and associated risk factors, both at the individual and societal levels.

In Belgium, Sciensano will coordinate the Belgian participation in JACARDI, embarking on a four-year collaboration with the Diabetes League, KU Leuven, and the University of Antwerp to refine the utilization of qualitative data, advance screening processes, and develop integrated care pathways.

Additionally, it will focus on leveraging digital tools to empower self-management for diabetes and cardiovascular diseases. This strategic partnership underscores Belgium’s commitment to pioneering innovative healthcare solutions and improving patient care.

France has also implemented a comprehensive national diabetes program that includes public awareness campaigns, screening initiatives, and improved access to diabetes care.

National diabetes registry

Ireland’s Department of Health told Euractiv: “There has been a significant shift in the quality and delivery of diabetes care in recent years, with more patients [in Ireland] being provided with care in the community and at an earlier stage.”

A spokesperson added: “Funding has been allocated to develop a National Diabetes Registry. A National Diabetes Registry will help to track the prevalence of the condition year on year, measure health outcomes for patients, and produce reliable data from which future services can be planned.”

They confirmed that a review of diabetes policy and services is currently ongoing. The Review is being led by the Diabetes Policy and Services Review Steering Group - the Steering Group will submit a report within six months of the commencement of their work. This report will include key findings, recommendations, and a set of actions to improve service delivery and patient outcomes.

Ireland has also launched a public health campaign ‘Building A Healthier Food Environment’   to “address the wider, commercial determinants of health which impact on our food environment.”

These impacts include the introduction of a sugar-sweetened drinks tax in 2018 which is currently being independently evaluated, supporting food reformulation - reduction of calories, fat, salt and sugar content - across a range of food products through the work of the Food Reformulation Task Force which is examining how to regulate the marketing of unhealthy food to children.

As Europe works towards creating a true Health Union, the EU will continue to haemorrhage funds on diabetes. With millions of lives affected, and billions of Euros failing to stem the advance of diabetes, a bold vision is needed to arrest this modern plague.

[By Brian Maguire | Euractiv's Advocacy Lab ]