Diabetes occurs as a consequence of the human body being unable to produce sufficient amounts of the hormone insulin, which regulates blood glucose, or to use insulin effectively. People with diabetes are unable to metabolize glucose appropriately and as a result, blood glucose levels remain above normal levels and over time can damage blood vessels. This can lead to long-term damage and disabling and potentially fatal health complications. In high-income countries, including Ireland, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure and lower-limb amputation.
The most common form of diabetes is type 2, which typically occurs in adults, although it is increasingly seen in young people, including children. Type 1 diabetes typically occurs in children or young people. The third main type of diabetes is gestational diabetes, which occurs because the action of insulin is impaired during pregnancy. Gestational diabetes is becoming increasingly common against rising levels of overweight and obesity as key risk factors. Those with type 1 diabetes require a regular supply of insulin, while type 2 diabetes is largely preventable and complications can be avoided or delayed through a combination of lifestyle changes, medications or insulin therapy, depending on the status of the condition and the stage of the disease in the person concerned.
Globally, the number of people with diabetes has doubled during the past 20 years, making it one of the most important public health challenges facing national health care systems today. The International Diabetes Federation has recently (2019) estimated that approximately 463 million adults (20-79 years) were living with diabetes globally and that by 2045 this will rise to 700 million. In Ireland it is estimated that there are 190,000 people with diabetes. Approximately 30,000 (15%) of these have Type 1 diabetes, or genetic or secondary causes of diabetes. The remaining 160,000 (85%) patients have Type 2 diabetes with a significant proportion of these patients remaining undiagnosed. It is expected that the number of people with Type 2 diabetes will increase by 60% over the next 10-15 years.
The challenge posed by the changing disease burden has been recognized globally, with diabetes featuring high on national and international agendas including the World Health Organisation and the European Commission. At national level countries in Europe have made progress towards developing a systematic policy response to the diabetes burden. Effective treatment reduces the risk of disability or fatal complications and its optimal management requires coordinated inputs from a wide range of health professionals, access to essential medicines and monitoring, and, ideally, a system that promotes patient empowerment and well-coordinated care. In that context in Ireland the HSE Clinical Programme in Diabetes leads the multidisciplinary coordinated response to the challenges posed by diabetes in Ireland and I have asked them to examine the matters raised by the Deputy and provide a response to him as soon as possible.