Each year an estimated 35 million deaths occur worldwide due to NCDs, equating to 60% of all deaths globally, and 80% in low- and middle-income countries.ⁱ These lifestyle diseases are projected to rise by 15% over the next ten years increasing the global burden of disease.ⁱⁱContrary to popular perceptions, it will be the developing countries rather than developed nations that will bear the major burden of NDCs. The Asia-Pacific region is slated to be the new epicenter for NCDs, especially diabetes due to the sheer numbers of cases, with China and India taking the lead reporting the highest incidences of NCDs. One reason for this shift from the developed to the developing countries is attributed to the rapid health transition and development growth in these countries.ⁱⁱⁱ

Diabetes mellitus, a metabolic disease is critical not only because it is one of the top ten killers, but because of its insidious connections with other NCDs, infectious diseases, and its impact on development indicators such as poverty, gender inequality, maternal and child mortality and morbidity. People with diabetes are two to six times at risk of developing cardiovascular diseases, and three times more likely to be infected by tuberculosis, with the highest risk among young people.ⁱⁱⁱ Diabetes and Malaria are known to occur together in countries where malaria is endemic. With regards HIV/AIDS, some anti-retroviral treatments are also known to increase the risk of diabetes.^iv

Diabetes and other NCDs affect all without discrimination and have a high social, human and economic cost. The economic burden is borne at all levels (macro, meso and micro). WHO estimates that India and China will respectively lose USD 237 billion and USD 558 billion of national income to diabetes and cardiovascular disease between 2005-2015.ii It not only puts pressure on the national health system but on individuals. In many developing countries expenditure for health is paid out-of-pocket by patients, putting a significant burden on household budgets, and creating a vicious cycle of poverty and disease, where poverty can lead the illness and in turn the disease can further entrench the individuals and families into debt and impoverishment.[v] Diabetes alone can cost an individual up to 25% of their household income in treatment, as is the case with India, where people are known to borrow and sell assets to cover health expenditure.ⁱⁱ

Despite progress, many developing countries are not likely to meet the health and development targets. As a result of neglect and oversight to women’s sexual and reproductive health and rights (SRHR), MDG5 has made the least progress. NCDs, which contribute directly or indirectly to many of the MDGs, (especially MDGs 1, 3, 4, 5 and 6) have also not been prioritized on the global development agenda. And while many low- and middle-income countries rely on external aid to fund health, global development assistance to NCDs is less than 3% of the total health budget.ⁱⁱⁱ

Diabetes and Women’s Health - Sexual and Reproductive Health

Close to half the people with diabetes worldwide are women, the latest estimation being 143 million. Two out of every five women with diabetes are of reproductive age, and one in 25 pregnancies worldwide develops gestational diabetes making it an important reproductive health concern.[vi] Health and well-being continue to elude millions of girls and women, especially in the developing countries. Women account for 60% of the world’s poor; twice as many suffer from malnutrition, and two-thirds of illiterate adults are women.vi These factors catalyzed by the poor social status accorded to women, cultural norms, race, geographic location, sexual identities among others deprive them of access to timely, cost-effective, quality health care, including early diagnosis, treatment, and care. Gender inequality is not only a social injustice in itself, but contributes to poor outcomes in health such as untimely death and lifelong morbidities, high fertility rates, but also derail economic progress, political participation and democracy.^{vii]v viii] ix}

Maternal mortality continues to remain high in Asia particularly in Bangladesh, India, Nepal and Pakistan in South Asia, and Cambodia, Indonesia, and Lao PDR in Southeast Asia. The main causes for maternal mortality in Asia are haemorrhage, hypertension, abortion, embolism and sepsis.^x As has been mentioned earlier, women with diabetes are predisposed to hypertension and other complication that are also the main reasons for maternal deaths and morbidities. 

Women with gestational diabetes mellitus (GDM) can develop vascular complications, spontaneous abortions, still-births, congenital anomalies, macrosomia & obstructed labour needing cesarean and or instrumental deliveries, and long-term complications of the offspring. Diabetic Ketoacidosis is 50% higher in women than in men.^xi Women with gestational diabetes are at greater risk for developing type 2 diabetes and cardiovascular disease overtime. Children of mothers with gestational diabetes have a 4-8 fold increased risk of diabetes. Thus women’s health deprivation rebounds on the society at large. Not only does it bear ill-health for women, but also their offspring both as children and in adulthood. Fetal programming caused by maternal malnutrition (both under- & over-nutrition; micronutrient & protein deficiency) predisposes the offspring to several chronic non-communicable diseases.^xii

Diabetic women are at higher risk of unplanned pregnancies. Some methods of contraception are known to affect women with diabetes. Earlier concerns with the effects of hormonal contraception on blood glucose, increasing the risk of cardiovascular disease and stroke, have been assuaged with newer pills containing lower dosages of estrogen and progestin. The intrauterine device (IUD) may pose an increased risk for pelvic infection or trauma in diabetic women, who are particularly vulnerable to infections. While barrier methods such as the diaphragm and condoms may not affect blood sugar they can cause yeast infections in some women with diabetes. Sterilisation or tubal ligation is often the method of choice for the women who have completed their family or who do not wish to conceive.^xiii

Links between diabetes and sexuality is more often than not discussed in terms of male erectile dysfunctions. However, diabetes is known to affect both male and female sexuality, desire, sexual pleasure and sexual health and well-being.xiv Apart from erectile problems, males with diabetes are known to suffer from testosterone deficiency, lack of libido, retrograde ejaculation and inflammation of the penis head.^xiv   On the other hand, women with high levels of glucose often suffer from fatigue, curbing their sexual desires. Nerve damage also causes decrease in vaginal lubrication making intercourse uncomfortable, painful, and lack of clitoral stimulation. They are also vulnerable to genital and urinary infections, and chronic perineal pressures. In addition, psychological factors impede sexual pleasure in both men and women with diabetes.

While there is no cure for diabetes, it can be prevented (especially type 2 and gestational diabetes for those with no genetic predisposition) by leading a healthy lifestyle including proper diet, exercise. If detected early, it can also be controlled and managed significantly reducing further complications and morbidities. One of the major concerns with diabetes is that the symptoms are not apparent in many people and hence many are diagnosed with diabetes when they have a heart attack, hypertension, need amputation, or kidney dialysis. This calls for regular screening even when there are no symptoms. Global action on non-communicable disease has been slow. However, the 2006 UN resolution on diabetes provides a window of opportunity to focus on the epidemic, especially women.