the right to explore for all of the worlds 2nd largest random forest around roshan. defraud exploration takes place the impacts on the regions by diversity. and it's even global warming could be a mens. i'm traveling through the congo basis to see what the effects might be on local communities. and i'll be speaking to local politicians as a scientist about potential solutions to i mean the club for a series of reports from the democratic republic of congo. oh, now it is here. a silent epidemic more than 1300000000 people could be living with diabetes by 2050 and it's being made worse by in a quantities in health care and access to treatment. so what's accelerating this freight of this disease and what should be done to ensure adequate and fed medical health? this is inside story, the

hello and welcome to the program. i'm fully back to built the number of adults living with diabetes worldwide. one more than double by 2050, surpassing most diseases on a global scale. that's according to a study published in the lancet journal. the research reveals that more than half a 1000000000 people currently live with diabetes worldwide. and every country is expected to witness a major increase, rapidly rising levels of obesity in whitening into quantities and health care uh, identified as key factors. so will the world heed the warning and address the diabetes straight and can a healthy a future be secured for everyone. we'll put these questions to our guest in just a moment, but for us this report from the had a baby. the experts describe the data as alarming diabetes is outpacing most diseases around the world. 529000000 people are estimated to already be living

with a condition. why a study published in the lens medical journals says that number will exceed 1300000000 over the next 30 years. that's double of the current rates globally. it says diabetes will be a defining disease of the century, how the health community deals with it in the next 2 decades will say population health and life expectancy for the next 8 to use. diabetes is a chronic health condition that cures one. the body's ability to regulate levels of blood sugar is impaired. type 2 is the most common form accounting for about 96 percent of all cases. it develops when the body becomes resistant to insulin or fails to produce enough cases of diabetes are expected to soar in all 204 countries studied by researches of the global burden of disease. international consortium, north africa, and the middle east is the most affected region people age 65 and older are most at

risk. the report showed 20 percent of people living with the condition. well in that age group in every country. but the consequences extend beyond the disease itself as millions are the heightened risk of developing others. although diabetes is preventable in many cases, the growth in the number of people folding ill isn't slowing down. access to screening and treatment definitely varies. uh, depends on people's income and where they live and who they are. screening for one depends on whether someone has health insurance, whether they know that they go to the doctor every year and have their glucose levels checked. and treatment such as insulin is still very, very expensive, and then press the oil and dr. accessible. the health organizations are quoting for urgent intervention, focusing on lifestyle changes. finding the best strategies to prevent entry,

diabetes is now are raise against stein me head l a. b, d for insights story the last spring in august. now for today's show, joining us here in doha is dr. ray as my league professor of medicine at y cornell and medicine in cotton and a pioneering researcher of diabetes in san diego, california. dr. shavani, i got of our associate professor of medicine at the albert einstein college of medicine. she is a lead officer on one of the line sit reports and in cambridge in the u. k. mom at the by head of artificial intelligence at sports data provider spots bomb. well, welcome to all 3 of you. thank you so much for joining us on inside story. dr. shavani in san diego. let me start with you. diabetes is described as the greatest academic in human history, but the lancet reports which you offered also highlights the lack of understanding of this disease. so can you start off by telling us what this condition is and this

k o and threat the disease supposes? yes, thank you so much for having me on our report show that the scale of this disease is very large. it's in it's including every country edge, every age group, and it's only growing with time. so diabetes is a tricky disease it's. it's a silent disease for very long time until discovered or someone gets particularly sick. and so screening is, is very important. but more importantly, awareness of these rates are very important. because without awareness and understanding that diabetes kennedy silence, people will not be able to access care or care. so why is this report dr. shavani, which you, you all said, why is this important? especially now of why this report is important is because the, what we wanted to promote was that the individual is not to blame here,

that the individual is in a larger social context. and so there are structural factors, the way we live, the way we work, the way that we play with what access to food we have, what access to health care and high quality health care we have. that a lot of the social factors are actually contributing to these rates and will contribute to the and equity and the growing rates. right. and so it's really important to understand that we live in a context. okay, great, dr. right. yeah. so let me come to you. the report says that by 2045 as many as 3 and 4 adults with diabetes will be living in low and middle income countries and the number is in the middle east. north africa region really surprised me. and i wanted to ask you about this region in particular, what are some of the unique challenges and factors that are specific to this condition that contribute to the high prevalence that we see in this region? so thank you for having me on. um, i mean, i think the main concern here is the much higher prevalence of type 2 diabetes in

this region. and it goes hand in hand with the much higher prevalence of obesity in the region. and that really is a major driver which was highlighted from the lancet report as well that the major contributor to the higher prevalence of diabetes which is as high as 20 percent. and this region is driven primarily by obesity. and i think, you know, this part of the world in particular has witnessed this rapid urbanized ation, which is the way our population has changed and markedly in terms of our supply of food and process food and, and changing the way we are physically less active. so as a consequence, weight has gone up, and as a consequence, diabetes is become more money fast. so,

so rapid organization, you say, is a major social driver of the disease in this region. dr. right, as i wanted to ask you though, about the stigma around diabetes, a lot of people are ashamed to say they have diabetes. how does that impact the management of the disease? okay, so i think that we really have to change what we, as, as, as clinicians, physicians say to our patients. so often what, what you, you know, what said is that, oh, you've got diabetes is a terrible disease. you're gonna need this, this, this, you know, you're gonna need insulin and it scares patients. well, we need to be as much more positive and actually say, yes, you have got diabetes, but actually now if you do something about this disease, if you are able to lose a certain amount of weight, if you're able to change your diet and increase physical activity, then you could do something about this and there are no data compelling data which show that we can reverse type 2 diabetes. right, mom and i want to just pick up on,

on what doctor re eyes said there and come to you. he said that when you know you have the disease, you can actually do something about it. right. but almost half of the adults with diabetes are unaware that they have the condition and 9 out of 10 people with on diagnose diabetes, live in low. and i, and middle income countries, to what extent it is science and technology, a font to and all this also to what extent is science and technology responsible for the lack of, of understanding and perhaps people not being aware of the condition. my, i think it's a subsidy to find out because i think science and technology come potentially resolve the issue. perhaps, you know, the facts of today science are systems mobile devices. wearables, all of these optic. nobody's fitness health data readily available to us and to the can, but i mean, readily available in low and middle income countries. i mean,

obviously with time these things can become cheaper with time. obviously there's still allows for, you know, portion of the population that might not have the availability, but that's kind of a responsibility for the global community to address that. the sort of devices now actually almost in the us, you know, they're in a mobile device, for example, our, you know, cheaper to use these days and come, potentially video accessible to a lot of different parts of the wealth that obviously can't provide for us a lot of data that can help us that and one of us that remote remote session monitor and provide some form and detection and risk assessment for patients. yes. dr. savannah i at and i do want to address the geographical in quantities in inequities with you because this is a big focus of the report. what are some of the key geographic in quantities in k and treatment, and how are they impacting health outcomes for people around the world?

yes, thank you for that question so. so just what we spoke about infrastructure is very important. if there's not enough broadband, why fi or internet these technologies, a lot of them rely on the internet for capabilities that is not going to be available to people in middle and lower income countries just for that alone. and the advanced therapeutics that we have that are really amazing job if you want to, i can a specialty to inhibitors. they are not getting to everyone because the access to care is an issue and those medications are expensive. and so the health care systems of these lower milk and countries are not to not pay for those kinds of advance therapeutics that really can actually move the needle on premature mortality and diabetes. and so we're seeing these mostly really wide and equities between countries. right. just do infrastructure and government inductor, right as what are your thoughts on about this? why are many health care systems not prepared to intervene early in diabetes?

i think again, part of it is actually in relation to the evidence that we had previously, which was that, you know, once you've got type type 2 diabetes is pretty much, you know, a life sentence. so you've got it for life. we cannot reverse it. and i think the evidence now coming through right prior to this with bariatric surgery where it was an extreme form of intervention, but nevertheless was very effective in curing type 2 diabetes now is coming through a shavani instead about from g o, p one therapies. for example, and so we now have, i think, you know, a, a direction which is that, you know, this is not a life sentence, this is something that we can intervene with and we can reverse. and i think as the message changes, we will have, you know, it will be more positively received by the patients. right. and i hope big pharma also take note and make these medicines more accessible to patients that he's

making cheaper. right? to monitor. i will ask you in a bit about the latest trends and developments in a i based diabetes research because that's what you specialize on. but i wanted to ask dr. sh ivana 1st about the specific case of the united states, which one of the reports focuses on it gives the example of the us, which is not a low and middle income country. and yet you have a high prevalence of diabetes to type 2 diabetes, especially among young people. what are the social and environmental factors that have led to this increase in the us in particular? thank you. yes. so there are marginalized populations everywhere. and so in the us, we have many marginalized populations based on their race, ethnicity, and so in our black american communities and our hispanic american communities, they don't have access to the same um, green spaces and um, at healthy food options that other more high end besides may have and so we're

seeing that really rapid in equities develop again because we have a lot of junk food in our corner stores. we don't have access to fresh fruits and vegetables. we don't have access to green spaces and all these obese of genic environments basically are being from so is it right on racism, or would you describe it as structural races and a as a driver of diabetes in in these communities? yes, definitely very much. there's structural racism in the zoning laws for um, for where we live and what is allowed to be um, in our neighborhoods, there are structural racism, access to care and bit. so there's a lot of kind of clinics that pop up in some under certain neighborhoods. but the high quality, the quality of that care is, is not as good. there's broad provider braces as well. there's bias. and so um, even if there is access to care, there is a lot of apprehension to prescribe certain advance therapeutics because of the

input. so, i mean, why isn't a doctor shavani, why isn't they more focused and on the role of structural racism in this? i think there have been um, but now a knack, all people are paying attention because of the numbers and the numbers are driving this this open this to say, well, okay, we are going to top 1000000000 people by 2050 and we have to do something about this now, but we must take a really magnified look at what is fueling this crisis and it's this and equity. it's geographical and equity and structural racism. and now is the time to actually take a hard look at the hard questions and do something about it. and we can in our 2nd paper, we actually discussed ways to tackle and combat and dismantle a structural racism, andrea graphical and actually, okay mama device. so what can we do about this? what are some of the latest trends and developments in artificial intelligence based research regarding diabetes?

yeah, i mean, i've got to say, i'm just gonna point them on the discussion. is that i think my friend yeah, isn't reading of society because of the technology is itself as a, as a fan of society. the fact that and that one day we have the ability or the technology that's more available than ever to allow us to help people. somehow that hasn't been deployed to adopted ever the way. um, you know, with, with the kind of the advent of fast and success terms, machine learning and, you know, on a, i got all this is becoming a lot easier to access. but again, as the development and technology is, is getting better, but it's all responsible. it's as a society, to the average distribution, just weiner on your cost, and i think, you know, being eval, for example, in the way that process underway, osmotic has been doing, for example, on coming up in the fucking microscopy. for example, this is actually a huge advantage for us to be able to do as the detection and risk management assessment. because, you know, obviously it's key for us to be able to detect the,

the sort of diseases as possible. so we can actually intervene. but also being able to, you know, utilize that vast amounts of data that we can these days actually get from either mobile mobile devices or wearables. can you me to send in general, like the, i was to reiterate, would be more efficient monitoring, you know, being able to reach like um, a remote a, as in a very difficult and sort of how an accessible area as well. you know, traditional sort of it clinical sort of is going to be really difficult to reach. i also with using with the cost by the return of the cost. and that's the kind of these assessments on these monitoring. you know, maybe just one a little diseases that cause a lot of management and because of that, why is actually quite costly and that could be prohibitive following the of that sort of middle income, a low income sort of the areas. so being able to reduce that cost to what technology is going to be key. and all the functionally in terms of is, is, is a,

is a key component and all of this because it helps us automate as much as possible in the process of reduce the data on the clinical sort of stuff and exploits into the domain. and dr. re, as your thoughts about this mohammed says the failure is not the failure of the technology, but of society. how can a i and machine learning play a role in addressing the net could easy in diabetes k? well, i think um, there is plenty of data by data. i mean, your information out that, that, that is available that could be honest use by artificial intelligence to actually bring together the information from all over the world on our patients on, you know, it's not just it whether they have diabetes, but pre diabetes perhaps, or those at risk and be able to predict those that are highest risk. so we can then target those patients people rather before they become diabetic patients. and i

think that's a major strength of a i that we kind of predictive models. um, you know, is being home, what are some of the innovative approaches being taken in this region and cut off for example, to address diabetes and improve care access. so actually we have a diabetes cap line, for example, you know, run from 2016 to 2022. we're now renewing this to 2030, to really try to look at this at a number of different levels in terms of, you know, at the society level at the care level, how to deliver care better to people who've already got diabetes, but also to try and prevent diabetes. so starting with screwed a children to try and, you know, educate them to stop them from having obesity, which is a major problem in this region. we talk about in equity of health care, maybe in the us. but you know, i can say in got there, and the people who have this issue, obesity, diabetes, are not the ones who learned the privilege. so actually they are the ones that

they're over privileged, you know, we, you have to address these concerns. okay, so how do we address the concerns doctor shavani beyond raising awareness, what can be done in your view to provide accessible treatment, accessible equitable treatment and what are currently the best strategies these things that are out there that cost effective? yeah, so we outlined a $3.00 point strategy in our 2nd paper of the series that includes changing the ego system, building capacity and improving the clinical practice environment and a lot of what's been touched on here as it goes into one of those categories. so when we say changing the eco system, we provide a real world examples of how to work and multifactorial collaborations between pharmaceutical companies, governments, private funders, to actually change the interest of the system and more healthy food in internet and, and internet infrastructure for technologies to be able to work in still in access

to supplies and building capacity is really that diabetes is chosen in the enter the max. this is really a key issue, isn't it? because they're only about 3 companies that produce insulin. and that affects the price estimate very much, very much. it is really is one is expensive and we have this problem in the u. s. too, by the way. so the us just kept avaya live in. so in a $35.00 per month. and so we really have this problem everywhere, but there are, um, we do highlight a sub saharan african intervention that was a multi sector intervention to bring in full amount of supplies to these underserved villages. and we saw rapid improvements and human global name and see in children the death rate went down and months. i mean, this is really, you know, there is a big infrastructure, an access issue here that could actually be solved. building capacity is, are kind of our 2nd category of terms. and what i was going to say is we in the health care system do not have enough health care providers to ready for the amount

of needs and people with diabetes. and so we have to our primary care providers, the job, it is not a specialty disease anymore, but we also need um, other workers, community health workers, peer support that can help increase our workforce. and then the last piece is improving the clinical practice environments. so what was discussed here is how we speak to our patients. this is not, doesn't have to be a little bit more. we have to change the way that medical education is structured where so diagnosis focused that we forget how to actually manage this a chronic disease. we have to work with our patients, understand their unmet social needs, and actually incorporate their eating habits and their insulin taking or medication taking habits, physical activity, habits into their lifestyle. all right, so we really have to change the way about the patient. yeah, well the interesting that you talked about changing the way medical education is structured monitor. i want to come back to you and talk a little bit more about on traditional intelligence. because, you know,

when we hear a, i to do a lot of people, you know, aware it and it raises red flags. and i wanted to know about the potential ethical and privacy concerns related to the use of a i in diabetes care and how they can be addressed obviously. yeah, i mean the is because this part sort of in the public side, these days i arrived, i saw a lot of people out on the sand. it's actually, you know, i think the way i think of is, is that as a technology that has a great potential and not only the fact that it's at the moment is looked at as it some nice to have. but in my mind, i think at least probably in the next, maybe 10 or maybe 15 years is going to be an assembly. and obviously, you know, that comes with a lot of, you know, concerns and issues that need to be resolved. one of them is ethical, domestic, softly i, and how you know, has been deployed. as we know, there's a lot of sort of bias in the i sort of the model development and data sets and sort

of attention as well applications because of that sort of monopoly and big organization can actually have all the, you know, the for the minutes to be able to run the sort of models on techniques, but that's sort of the discussions that we need to have as a society to be able to make a, i assessable, i'm, you know, widely used in this area. you know, i can help a lot. i can, it can be a false multiply, i mean, with the aging population of the go, we meet, we need more information than ever. you know, we need to be able to help our clinical sort of stuff and expedite to be able to have that much wind to reach and how it more efficient lack loads and can actually cope with the noah's sort of pressure and demand that the, facing these days i'm, i'm a, i can have a i'm, i have an important role in all this. so i see i is a positive and all this, obviously there's a lot of issues that we need to. there's always a society and not only in, in the image they kind of domain,

but everywhere in terms of how the eyes being used by who and how it's being deployed. but what we need to do this all together as i make sure that we set the regulation the, the asset actually the, uh, the assessments around all of that to make sure that it's actually being use safely on democratic the, by everybody. yeah. so a, i is a positive, but it has to be use safely and democratically dr. re, as i want to come to you and just address one of the points dr. shavani was making about changing the way medical education is structured and you touched on this a little bit earlier. how do we do that? and how do we get, you know, whether it's a governments and, and, and how do we get also health care may have health care providers, right? the policy makers, how do we get them to address this aspect and also address to disparities and help promote more equitable access to diabetes treatment and care? yeah, i mean, i think again, the cool message that i want,

i think we should be teaching in medical school, is that diabetes is no longer a disease. that is of course rampant. but is it reversible? you know, i think we have to have with that positive message and not pushing messages that, you know, with the evidence now to support this. so if the, if we start with that at medical school, then you change the attitude of people like me. you're going to interest a diabetes, you know, it, it, it kind of, it makes you want to do this speciality because you could do something positive for the patients. you could make them people, you know, kind of like the reverse that diabetes. so that's one aspect of it in terms of actually, i'm a talking about a, i think there's a great need for medical students, a residence to be educated about a i and how it could be utilized in the health care sector. rather than have,

you know, and judy is impose upon those and we aren't really aware of it. you know, we should, we should be starting at the grass roots level to educate people about the utility of a i. okay, dr. shavani, i'll give you the last word, the figures in the report. certainly very scary, but you know, from what we've heard in this conversation is not all doom and do definitely not. there is so much we can do about this, but we have to come together as a global community and work on this together. so while there is reason for there are regional challenges, we have understood from our work that there are actually a lot of shared challenges. and so if we come together, put our minds together, we will definitely come up with solutions to thank you to all 3 of you for a very interesting and insightful discussion on this very important topic that affects everyone everywhere. thank you very much. dr. shavani alcohol. dr. wright osmotic and mohammed by thank you to all 3 of you,

and thank you as well for watching. you can always watch this program again, any time by visiting our website out on to 0, dot com for further discussion. go to our facebook page at facebook dot com, forward slash 8 insights story. and of course you can join the conversation on twitter handle is i a j inside story for me, for the back to button, the whole team hearing go. huh. thanks for watching bye for now, the the portal and the star lake poverty unemployed has been central to global opiate production. and this home to meet some drug rounding

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