Europe spends more on diabetes per year than it does on the war in Ukraine. The diabetes tsunami is a public health crisis that threatens to overwhelm health systems and developing economies.
The amount Europe spent on diabetes last year was more than the total EU funds donated to Ukraine since the Russian invasion. The incidence of diabetes, especially preventable type 2 diabetes, is increasing at an alarming rate due to factors such as obesity and an ageing population. The annual cost of diabetes in Europe is limiting the continent's economic growth.
In 2021, diabetes-related spending in Europe totaled approximately €170 billion, accounting for 19.6% of global diabetes-related spending. The average annual cost per person with diabetes in Europe was approximately €2,760.
In contrast, Europe has committed €150 billion to financial, military, humanitarian and refugee assistance, including funds allocated through the European Peace Facility until 2027.
Prevalence of diabetes in Europe
Spain recorded the highest diabetes prevalence in Europe in 2021, with around 15% of adults diagnosed with the disease, followed by Portugal at around 13%.
In most European countries, the prevalence of diabetes is reported to be around 8-9%. The Czech Republic had the highest diabetes-related mortality rate in 2021, with 43.4 deaths per 100,000 inhabitants, and across Europe, men are significantly more likely to die than women.
“The diabetes tsunami in Europe is a public health challenge that requires urgent and concerted action,” a spokesperson for the Irish Department of Health told EuraActive.
But they added that “with the right policies and interventions it is possible to reduce the impact of diabetes and improve the quality of life for millions of Europeans.”
put a strain on the economy
The economic burden of diabetes on European health systems is substantial, but universal healthcare systems prevent these costs from being passed on to patients: in 2021, around €11,600 was spent per person with diabetes in Switzerland, compared with €5,200-6,000 per person per year in the UK, France and Germany.
Germany has the highest rate of hospitalizations due to diabetes at 172 per 100,000 people, while Romania and the Czech Republic report more than 18 lower limb amputations per 100,000 people with diabetes.
Global surge: diet is to blame
The global prevalence of diabetes is rising sharply and is predicted to reach 12.2% of the population by 2045. While type 1 diabetes remains unpreventable, 95% of diabetes cases are type 2, which is affected by ageing, unhealthy diet and sedentary lifestyles.
In 2021, more than 30% of the population in more than half of European countries are insufficiently physically active, and soft drink consumption, a risk factor for obesity, will reach an average of 98 liters per person in 2022.
Diabetes is one of the most common chronic diseases in the WHO European Region, and Europe has the highest burden of type 1 diabetes globally.
It is estimated that one in ten people in the region will have diabetes by 2045. The number of adults with diabetes in Europe is projected to increase from the current 32 million to 35 million by 2030.
Economic impact
These costs include direct medical costs such as hospitalization, medications, and outpatient care, as well as indirect costs related to lost productivity and premature death.
In France alone, the total direct medical costs of type 2 diabetes are estimated at €29 billion per year.
Currently, 4 million people in France have diabetes, a figure that has increased six-fold in just 30 years. 90% of diabetic patients in France have type 2 diabetes, and nearly 700,000 of those with diabetes are unaware they have it.
France ranks 26th out of 189 countries in the Human Development Index (HDI), with diabetes prevalent among the most vulnerable social groups and much higher prevalence in the most disadvantaged cities.
The prevalence of diabetes in France is currently 5.4%, one in two French people is overweight and 15% suffer from obesity. Diabetes costs France 19 billion euros per year, accounting for 15% of health care costs.
European policy response
Recognising the urgent need to address this crisis, the European Parliament adopted a draft resolution in November 2022 on preventing, managing and better care of diabetes in the EU.
The resolution calls on Member States to develop and implement national diabetes plans, ensure equitable access to treatment and promote diabetes education, and stresses the need for stronger EU leadership and cooperation with Member States to achieve these goals.
The Blueprint for Diabetes in the European Union to 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
The Irish Department of Health told EuraActive: “Recent policy initiatives from the European Union and WHO recommendations provide a solid foundation for tackling this crisis. However, continued effort and collaboration at all levels will be essential to turn the tide on diabetes and ensure a healthier future for Europe.”
The World Health Organisation (WHO) has emphasised the importance of early diagnosis and effective management to prevent complications and is actively working to tackle the diabetes crisis in Europe.
According to the WHO, diabetes is a leading cause of blindness, kidney failure, heart attacks, strokes and lower limb amputations.
The WHO Declaration on Accelerating Efforts to Improve Diabetes Detection and Quality Care highlights the need for an integrated, people-centred approach to diabetes management, including promoting screening for diabetic retinopathy and improving access to essential medicines and technologies.
National Initiative
As a result of EU and WHO efforts, several European countries have implemented national diabetes plans to combat the rise in diabetes, including Slovenia, which has developed a comprehensive 10-year plan focusing on diabetes prevention, early detection and integrated care. Latvia also aims to improve access to diabetes medicines in line with WHO recommendations.
Last November, a new four-year project called Joint Action on Cardiovascular Diseases and Diabetes (JACARDI) was launched in Rome. The initiative, involving ministries, public health agencies, non-governmental organizations and universities, aims to help European Union (EU) member states reduce the burden of cardiovascular diseases (CVD), diabetes and related risk factors at both individual and societal levels.
In Belgium, Sciensano is coordinating Belgium’s participation in JACARDI and has embarked on a four-year collaboration with the Diabetes League, KU Leuven and the University of Antwerp to improve the use of qualitative data, advance screening processes and develop integrated care pathways.
Additionally, there will be a focus on leveraging digital tools to enhance self-management of diabetes and cardiovascular disease. This strategic partnership underlines 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
The Irish Department of Health told Euraactive that “in recent years there have been major changes in the quality and delivery of diabetes care, with more patients (in Ireland) receiving care in the community and at an earlier stage.”
The spokesman added: “Funding has been allocated to develop a National Diabetes Register, which will help track diabetes prevalence annually, measure patient health and generate reliable data to plan future services.”
It was confirmed that a review of diabetes policy and services is currently underway. The review is being led by the Diabetes Policy and Services Review Steering Group, which is due to deliver its report within six months of starting its work. The 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 called “Building Healthier Food Environments” to “address the wider commercial determinants of health that impact on the food environment”.
These impacts include the introduction of a sugary drinks tax in 2018, which is currently being independently evaluated, and supporting food reform (reducing calorie, fat, salt and sugar content) across a range of foods through the work of the Food Reform Task Force, which is looking at ways to regulate the marketing of unhealthy foods to children.
As Europe strives to build a true health union, the EU will continue to squander funds on diabetes. With millions of lives affected and billions of euros failing to halt its progression, a bold vision is needed to halt this modern epidemic.
