Author: Dr. Sania Nishtar (writing for the
International Diabetes Federation)
I recently had the privilege and the opportunity of travelling
around the world as one of the three nominees for Director-General
of the World Health Organization (WHO).
Wherever I went, in addition to presenting my candidature, I
utilised the opportunity to visit hospitals, hospices, primary
healthcare centres and communities-and everywhere, I found the
footprint of diabetes disturbingly ubiquitous.
The official figures are estimated at 415 million adults
currently living with diabetes and these estimates are projected to
increase to 642 million by 2040. Approximately 199 million women
live with diabetes which is projected to rise to 313 million by
2040.1 I fear this may just be the tip of the iceberg.
Girls and women with diabetes experience a range of challenges.
Power dynamics, gender roles and socioeconomic inequalities
influence vulnerability to diabetes, such as by exposing women to
poor diet and nutrition and physical inactivity
These factors also affect women's access to health services and
health seeking behaviour, and amplify the impact of diabetes on
women, particularly in developing countries.
Diabetes is one of the leading causes of cardiovascular disease
(CVD), blindness, kidney failure and lower-limb amputation.
In pregnancy, poorly controlled diabetes increases the risk of
maternal and fetal complications.
Diabetes is the ninth leading cause of death in women globally,
and causes 2.1 million deaths per year. Women with type 2 diabetes
are 10 times more likely to have heart disease and have
significantly increased risk of depression in comparison to
Globally, there are more deaths attributable to diabetes in
women than men.
These are not mere statistics, but facts which incur heavy
physical and emotional and economic toll on families.
The suffering of four sisters in my country, Pakistan,
epitomizes the problem millions of women face worldwide. At 44
years, Rehmat is the youngest of four sisters-all of whom are
obese. Recently Rehmat was hospitalised for a diabetic foot
amputation, a common and tragic outcome of uncontrolled diabetes,
which will place great difficulties and challenges for her ahead,
being so scarred at a young age.
Two of Rehmat's sisters are on dialysis, due to end-stage
diabetes-related renal disease, and already one sister has
undergone a heart bypass operation unsuccessfully.
All sisters suffer from serious damage to their eyes-another
complication of diabetes. The burden of care for the entire
extended family in emotional, physical and economic terms is
devastating. The opportunity cost weighs heavily in terms of the
wellbeing and future outlook for their respective families.
The ravages of diabetes are not confined to the realm of
noncommunicable diseases (NCDs) alone. In technical and public
health parlance, diabetes is clubbed together with the other NCDs,
and is as such siloed outside of the mainstream public health,
which is still dominated by infectious diseases and reproductive
and maternal and child health (RMNCH).
It is imperative that we recognise diabetes as an issue that
straddles both RMNCH as well as NCDs, as diabetes is a serious and
neglected threat to the health of mother and child. Two out of five
women with diabetes are in reproductive age and half of all cases
of hyperglycaemia in pregnancy occur in women under the age of 30,
accounting for over 60 million women worldwide.
One in seven births is affected by gestational diabetes (GDM).
IDF estimates that 20.9 million or a staggering 16.2% of live
births in 2015 had some form of hyperglycaemia in pregnancy. Women
with diabetes have more difficulty conceiving and may have poor
pregnancy outcomes. Many women with GDM experience pregnancy
related complications including high blood pressure, large birth
weight babies and obstructed labour.
A significant number of women with GDM also go on to develop
type 2 diabetes resulting in further healthcare complications and
Most alarming is that the vast majority of cases of
hyperglycaemia in pregnancy have been found to be in low- and
middle-income countries, where access to maternal care is
GDM can also leave its mark on women for life, as approximately
half of women with a history of GDM go on to develop type 2
diabetes within five to ten years of delivery. Women with type 1
diabetes have an increased risk of early miscarriage or having a
baby with malformations, in any case.
There is, however, a silver lining to this problem. We know that
the majority of cases of type 2 diabetes could be prevented through
the adoption of a healthy lifestyle.
Approximately, seventy percent of premature deaths among adults
are largely due to behaviour initiated during adolescence which is
where the potential of lifestyle modification is greatest.
This is where the role of women and girls is critically
important as they are the key agents in the adoption of healthy
lifestyles to improve the health and wellbeing of future
generations. As gatekeepers of household nutrition and lifestyle
habits they have the potential to drive prevention from the
household and beyond.
For all these reasons, I would like to lend my voice of support to
IDF's message on World Diabetes Day to its constituencies-a network
of thousands of foundations and societies all over the world.
This network has an enormous influence to cascade IDF messages
in their countries to governments, policymakers, civil society, the
scientific community and people in general to catalyse a whole of
societies approach to tackling this challenge.
At a broader public health and health systems level, diabetes
prevention and management, along with extensive measures aimed at
NCD prevention and control need to be mainstreamed in country
planning with adequate attention to the specific needs and
priorities of women with diabetes.
Women and girls should be empowered with access to knowledge and
resources to strengthen their capacity to prevent type 2 diabetes
in their families and better safeguard their own health. In
addition, type 2 diabetes prevention strategies must focus on
maternal health and nutrition and other health behaviours before
and during pregnancy, as well as infant and child nutrition.
Antenatal care visits during pregnancy must be optimised for health
promotion in young women and early detection of diabetes and
We can no longer afford to treat diabetes and NCDs as the blind
spot of our policies. There must be a conscious effort to drive
change. Constituents of IDF can be the drivers of that change. They
must marshal the much-needed momentum now, and as a matter of
right, not choice, not options.
Dr. Sania Nishtar of Pakistan is a former federal minister
and prominent global health leader with extensive experience in
public healthcare. She was among the three candidates nominated for
the post of Director-General of the World Health Organization (WHO)
1. International Diabetes Federation. IDF Diabetes Atlas, 7th edn.
International Diabetes Federation, 2015.
Diabetes Day 2017
The theme of World Diabetes Day 2017 is Women
and diabetes - our right to a healthy future.
The campaign will promote the importance of affordable and
equitable access for all women at risk for or living with diabetes
to the essential diabetes medicines and technologies,
self-management education and information they require to achieve
optimal diabetes outcomes and strengthen their capacity to prevent
type 2 diabetes.
All women with diabetes require affordable and equitable
access to care and education to better manage their diabetes and
improve their health outcomes.
- There are currently over 199 million women living
with diabetes. This total is projected to increase to 313
million by 2040.
- Two out of every five women with diabetes are
of reproductive age, accounting for over 60 million women
- Diabetes is the ninth leading cause of death in women globally,
causing 2.1 million deaths per year.
- Women with type 2 diabetes are almost 10 times more
likely to have coronary heart disease than women
without the condition.
- Women with type 1 diabetes have an increased risk
of early miscarriage or having a baby with
What needs to be done
- Health systems must pay adequate attention to the specific
needs and priorities of women.
- All women with diabetes should have access to
the essential diabetes medicines and technologies,
self-management education and information they need to
achieve optimal diabetes outcomes.
- All women with diabetes should have access
to pre-conception planning services to
reduce risk during pregnancy.
- All women and girls should have access to physical
activity to improve their health outcomes.
Pregnant women require improved access to screening,
care and education to achieve positive health outcomes for mother
- 1 in 7 births is affected
by gestational diabetes.
- IDF estimates that 20.9 million or 16.2% of live
births to women in 2015 had some form
of hyperglycaemia in pregnancy.
Approximately half of women with a history of
GDM go on to develop type 2
diabetes within five to ten years after delivery.
- Half of all cases of hyperglycaemia in
pregnancy occur in women under the age of
- The vast majority of cases of hyperglycaemia in pregnancy were
in low- and middle-income countries, where access
to maternal care is often limited.
What needs to be done
- Type 2 diabetes prevention strategies must
focus on maternal health and nutrition and
other health behaviours before and during pregnancy, as well as
infant and early childhood nutrition.
- Antenatal care visits during pregnancy must
be optimised for health promotion in young
women and early detection of diabetes and
- Screening for diabetes and GDM should be
integrated into other maternal health interventions and services at
primary healthcare level to ensure early detection,
better care for women and reduced maternal mortality.
- Healthcare workers should be trained in
the identification, treatment, management and follow up
of diabetes during pregnancy.
Women and girls are key agents in the adoption of
healthy lifestyles to improve the health and wellbeing of future
- Up to 70% of cases of type 2 diabetes could be
prevented through the adoption of a healthy
- 70% of premature deaths among adults are
largely due to behavior initiated during
- Women, as mothers, have a huge influence over
the long-term health status of their
- Research has shown that when mothers are granted greater
control over resources, they allocate more to food,
children's health and nutrition, and education.
- Women are the gatekeepers of household nutrition and
lifestyle habits and therefore have the potential to
drive prevention from the household and beyond.
What needs to be done
- Women and girls should be empowered with easy and
equitable access to knowledge and resources to
strengthen their capacity to prevent type 2
diabetes in their families and better safeguard their
- Promoting opportunities for physical exercise in
adolescent girls, particularly in developing countries, must
be a priority for diabetes prevention.