On Diabetes Worldwide

Diabetes mellitus affects more than 220 million globally, and is among the leading causes of death and disability worldwide. While nearly eight percent of the population of the United States is affected by diabetes - a figure which is expected to rise to 50 percent by 2020 - reports show that almost 80 percent of deaths due to the condition occur in developing nations. Experts indicate that in recent years more people with diabetes, particularly those in the developed world, are aware of their condition, but it is important to ensure that information is made available regarding not only how to manage the condition, but how to prevent it.

A chronic disease stemming from the body’s ineffective production or handling of insulin, diabetes may affect people at different stages of life, particularly childhood, adulthood, or pregnancy. Insulin is a hormone produced by the pancreas and secreted into the bloodstream to lower the amount of sugar in the blood. Excess sugar in the blood can lead to serious health problems, and individuals with diabetes must control their condition, often through monitoring their blood sugar levels and the administration of insulin either through frequent injections or an insulin pump. Type 1 diabetes; also known as insulin-dependent, juvenile, or childhood-onset diabetes; is characterized by deficient production of insulin. Though individuals with Type 2 diabetes, also known as non-insulin-dependent or adult-onset diabetes, often experience the same symptoms as those with Type 1 diabetes including excessive excretion of urine, thirst, vision changes, and fatigue, Type 2 diabetes results from the body’s ineffective use of the insulin it produces. Women may also experience gestational diabetes, which occurs in pregnant women as the placenta produces hormones to sustain the pregnancy which make the body’s cells more resistant to insulin. Reports indicate that in 90 percent of women affected by gestational diabetes, the condition resolves after delivery.

While Gestational diabetes occurs only in pregnant women, and Type 1 diabetes occurs primarily in individuals with a family history of the condition, anyone can develop Type 2 diabetes. Though some factors that contribute to Type 2 diabetes such as age and race cannot be controlled, others, including inactivity, weight, and body-fat distribution can be. According to the World Health Organization (WHO), 90 percent of individuals with diabetes have Type 2 diabetes, and a majority of these cases are the result of excess body weight and a lack of physical activity. Because these factors can also exacerbate the condition of individuals who have diabetes, experts recommend that precautions be taken, including maintaining a healthy diet, exercising, and carefully monitoring blood sugar and insulin levels.

Individuals with diabetes who allow their blood sugar and insulin levels to fluctuate too widely may experience disabling and potentially life-threatening complications. The risk of developing cardiovascular disease, nerve damage, and kidney damage are all greatly increased in individuals with diabetes, as are the potential for damage to the blood vessels of the eyes, nerve damage in the feet, and skin and bone problems. Reports indicate that diabetes increases the chance of foot ulcers and eventual amputation, is among the leading causes of kidney failure, and is responsible for nearly five percent of the 37 million cases of blindness worldwide.

In addition to these potentially disabling complications, if left unchecked, diabetes can lead to death. WHO projections indicate that by 2030, deaths due to diabetes and its complications may reach 2.2 million per year with the most rapid growth occurring in developing nations. Though treatment options are somewhat limited - with frequent blood sugar testing, diet, and an exercise regimen that includes weight training and aerobic activity being most effective - by understanding diabetes it may be possible to better control it and minimize the number of new cases.

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Maternal Mortality Worldwide

Worldwide, a reported 1,500 women die each day as a result of pregnancy-related causes. According to the World Health Organization’s (WHO) “Trends in Maternal Mortality” report, maternal mortality rates (MMR) worldwide have decreased, but remain a persistent public health concern. As noted in previous WHO reports on women’s health, medical staff and services, educational programs, and information pertaining to pregnancy and childbirth may be lacking in some areas. By ensuring that trained medical personnel are available, and that women are able to access pre- and postnatal care, MMR can be further reduced.

The number of women dying due to complications during pregnancy has decreased from 546,000 in 1990 to 358,000 in 2008 with an estimated 99 percent of these deaths occurring in developing nations. Reports indicate that women in developing nations are 36 times more likely to die from a pregnancy-related cause than those in developed countries. Though rates vary within and between countries due to differences in income and between urban and rural populations, the average risk of maternal mortality in developing nations is one in 75, compared with one in 7,300 in developed areas. According to experts, most maternal deaths are avoidable, and are due to four major causes: severe bleeding after childbirth, infections, hypertensive disorders, and unsafe abortions. In addition, approximately 20 percent of maternal deaths are due to indirect causes, including diseases that complicate pregnancy or are aggravated by it such as malaria, anemia, and HIV/AIDS.

Many of these deaths are due, at least in part, to a lack of trained medical personnel available to care for pregnant women and new mothers. WHO data show that less than two-thirds of women in developing countries receive assistance from a healthcare worker during childbirth. In addition to care during delivery, antenatal care is often limited in developing regions. In low- and middle-income countries approximately two-thirds of women have at least one antenatal visit, while in high-income nations nearly all women have at least four antenatal visits, receive postnatal care, and are attended by a midwife or doctor during childbirth. According to the WHO’s Colin Mathers, reducing the MMR worldwide will require countries, international organizations, and charities to collaborate to educate and train additional medical personnel to attend to pregnant women. Dr. Margaret Chan, Director-General of the WHO, has also stated that “No woman should die due to inadequate access to family planning and to pregnancy and delivery care.”

In addition to ensuring that trained personnel are available locally, telemedicine initiatives such as the iConsult program may prove beneficial in lowering the MMR. By combining a software application and website, iConsult may enables healthcare providers in remote and medically underserved areas (Requestors) to receive free advice on difficult cases from medical specialists (Volunteers) including Obstetricians and other maternal and fetal health experts. This type of telemedicine program may be employed to improve health outcomes and lower maternal mortality rates in regions where the necessary personnel are not available.

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On Cholera Worldwide

Though the last major outbreak in the United States occurred in 1911, cholera remains a persistent health concern in many parts of the world, including Asia, the Middle East, Latin America, and sub-Saharan Africa. Recent outbreaks have been seen in Nigeria, where cholera has killed more than 1,500 people this year, and in Haiti, where survivors of the massive January earthquake have been affected by an outbreak that has infected an estimated 2,300 people and killed at least 200. Due to cholera, there are an estimated three to five million new cases reported worldwide and between 100,000 and 120,000 deaths each year. Like other diarrheal illnesses, cholera is easily treatable and can be prevented through the provision of safe water, improved sanitation services, and education about the importance of hygiene.



Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Though three-quarters of individuals infected with V. cholerae do not exhibit any symptoms, they may shed the bacteria in their stool for seven to 14 days, potentially infecting others. While V. cholerae is the direct source of cholera infection, the deadly effects of the disease are caused by a toxin called CTX, that the bacteria produce in the small intestine of the host. CTX binds to the intestinal walls and interferes with the normal flow of sodium and chloride, causing the body to secrete large amounts of water and leading to diarrhea accompanied by dehydration. In individuals exhibiting the severe form of the disease, the rapid loss of fluids can lead to dehydration and shock, and without treatment death can occur within hours. Approximately one in 20 individuals infected with the bacteria develops symptoms associated with cholera, which include: severe, watery diarrhea; nausea and vomiting; muscle cramps; dehydration; and shock.

The rapid loss of fluids in a short period of time – often as much as a quart in an hour - associated with diarrhea due to cholera, makes the disease particularly deadly. In order to replenish the fluids and electrolytes that an individual with severe cholera has lost, Oral Rehydration Salts (ORS) must be administered. If a pre-formulated solution is not available, experts suggest combining one-half teaspoon salt, one-half teaspoon baking soda, and three tablespoons sugar in one liter of safe drinking water. With the prompt delivery of ORS, up to 80 percent of people can be treated successfully, with a fatality rate below one percent. Antibiotics may be used in conjunction with ORS to shorten the course and lessen the severity of the illness, however their delivery is less critical to cholera patients than rehydration. To help control the spread of the disease, two types of oral cholera vaccines are also available, but according to experts they provide only a short-term effect and should be administered in areas where ongoing water and sanitation improvement programs are in place.

Despite the simplicity of the cure, thousands of people die each year in regions that lack effective sanitation and water purification systems. Following man-made or natural disasters, the risk of an initial outbreak of cholera growing into an epidemic is greatly increased. As seen recently following floods in Pakistan and Nigeria, the spread of cholera becomes a major public health concern when there is a lack of clean water. By providing treatment as well as information about the importance of boiling water before drinking and maintaining personal hygiene, it may be possible to slow or even stop the spread of cholera and other communicable diseases.

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