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uring commemorations of World Diabetes Day on Nov. 14 we were reminded that currently 371 million people live with diabetes and another 280 million are at high risk of developing the disease globally. Half a billion people are expected to be living with diabetes by 2030.

Diabetes is a chronic, non-communicable disease (NCD) divided into two main types: type 1 and type 2. Type 1 is diagnosed primarily in the young, characterized by the absence of insulin and related to genetics.

Meanwhile, type 2 is usually diagnosed in adults, characterized by a relative insufficiency of insulin and largely related to the environment. Both forms lead to serious complications if not managed properly — including damage to sight and nerves, kidney disease, amputation and increased risk of cardiovascular disease, such as heart failure or strokes.

While what causes type 1 diabetes is largely unknown, type 2 is largely related to economic development. In the past, NCDs such as diabetes were often associated with developed countries and communicable diseases with developing countries.

This division was previously partly justified. However, this former “disease of affluence” is now the leading cause of death globally except in sub-Saharan Africa, according to the World Health Organization in 2011.

In fact, over 80 percent of the global diabetes population currently lives in developing countries, including Indonesia.

This burgeoning rate of diabetes and other NCDs leads us to wrestle with a double burden of diseases: While we have to remain vigilant in driving down rates of communicable diseases, we also have to prevent and treat NCDs.

Diabetes does not pass from person to person, in contrast to infectious or communicable diseases. This disease is of long duration and generally progresses slowly. The most important modifiable risk factors for
diabetes are an unhealthy diet, physical inactivity, or excessive alcohol consumption.

These factors may all be affected by lifestyle choices often influenced by economic development and urban living.

The social and economic transitions in developing countries may explain the shifting of diabetes to low- and middle-income countries, including Indonesia.

As our country is going through urbanization and modernization, we are exposed to several lifestyle changes that lead to less physical activity and unhealthy diets.

A main example of lifestyle change are the easy and affordable online delivery services. More and more restaurants, grocery stores, and clothing lines are contracting with delivery services to reach consumers who demand the convenience of home delivery. Shopping is just one click away with a reasonable service price.

However, online delivery could be feeding into Indonesia’s increasingly sedentary lifestyle, reducing walking and the movement needed to buy things in a store.

A second and similar contribution to a sedentary lifestyle is the more affordable online transportation. People used to walk hundreds of meters to reach public transportation, but now they can just sit to wait for their online ojek (motorcycle taxi), saving time and energy.

Last but not least: daily white rice intake. White rice is the predominant type of rice consumed by Asians and has high glycemic index (GI) values.

Compared to brown rice, it has fewer nutrients, including fiber, magnesium and vitamins.

On average, Indonesians eat three portions of white rice a day. Research by the Harvard School of Public Health shows the more white rice eaten, the higher the risk of type 2 diabetes, with each increased serving of white rice (assuming 158 grams per serving) contributing to a 10 percent increase in the risk of type 2
diabetes.

Then, how should governments in developing countries tackle this burgeoning problem? As urbanization and modernization changes lifestyles, governments should learn from countries with more established urban communities.

The Netherlands, for instance, facilitates and encourages physical activity by providing huge sidewalks and bicycle paths.

Neighboring Singapore’s government gives away free pedometers and rewards those who achieve the daily step goals. Public health should be a government priority in every process of creating new policies.

We can also start with ourselves and our families to live long and healthy lives. Small lifestyle changes can reduce the risk of diabetes. A study suggests that 150 minutes of exercise a week can reduce the risk of getting diabetes by 26 percent compared to being inactive.

Exercising 300 minutes per week can cut the risk by 36 percent. Reducing sugary food and drinks is also a must, as they
can cause sustained spikes in blood sugar and insulin levels, which may lead to increased diabetes risk.

According to research by the University of Gothenburg, people aged 35 and older who are frequently stressed are also more susceptible to diabetes. Thus, controlling stress levels through fun activity or meditation can also help keep diabetes at bay.

After all, diabetes is a chronic, debilitating and costly disease that threatens individuals, health systems and governments.
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