Transcript Diabetes as a Global Health Problem

Diabetes as a Global
Health Problem
The IDF meets the
Challenge
By
Prof. Morsi Arab
IDF Chairman MENA Region
MENA
Reported Incidence of Type1 Diabetes at the MENA Region
per 100.000 population under 15 yrs ( Diabetes Atlas 2006)
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Afghanistan
Algeria
Bahrain
Egypt
Iran
Iraq
Jordan
Kuwait
Lebanon
Libya
Morocco
Palestine
Oman
Pakistan
Qatar
Saudi Arabia
Sudan
Tunisia
Emirates
Yemen
1.2
8.6
2.5
8.0
3.7
3.7
3.2
22.3
3.2
9.0
8.6
3.2
2.5
0.5
11.4
12.3
10.1
7.3
2.5
2.5
At The MENA Regionِ
Prevalence of Diabetes is 9.2 % (age 20 -79)
Prevalence of IGT …….is 8.1 %
24.5 millions with Diabetes & 22.4 with IGT
out of the top 10 highest diabetes prevalence rate
countries 6 are MENA countries
Estimated death due to DM as % of all deaths is 11.5%
( 11.1% in Europe and 11.8 % in MENA )
Diabetes Mortality
World wide = 3.2 millions die from complications
associated with diabetes
In the ME : ( with high prev. of diab.)
one in 4 deaths in adults 35-64 years
is related to diabetes
MENA
The pyramidal structure of the
>
60
Egyptian population
-60
6.1
-50
age groups
6.3
- 40
9.3
13
30
14.3
-20
20.5
-10
30.5
0
5
10
15
20
25
30
35 %
Prevelance of DM in whole Egypt in
Different Age Groups
16
15.06
12.04
14
% population
12
8.25
10
8
6
4
3.08
2
0.62
0.80
0
Age Group
10
20
30
40
50
60
25
Diabetes Prevelance & Age Groups
Percent
20
15
10
5
0
20
30
40
50
60
>60
Age
Saini
Eastern desert
Western desert
Nubia
Prevelance of DM among age group ( 40 - )
in different communities
14.7%
14.3%
16.0%
14.0%
12.0%
8.5%
10.0%
5.6%
8.0%
6.0%
2.0%
4.0%
2.0%
0.0%
U
UN
RN
RA
RD
DIABETES IS PART OF THE WIDER
HEALTH PROBLEM : THE METABOLIC
SYNDROME
20-25 % of the world adult population have the
metabolic syndrome ( MTS) , and these are :
- 5 times at risk to develop diabetes type 2
- 3 times likely to have a heart attack
or stroke
- twice likely to die
“Obesity” is always involved , or
associated with all elements of the
Metabolic Syndrome :
But Which type of Obesity ?
“ Abdominal Obesity “ as measured by
waist
circumference is more indicative of the
Metabolic Syndrome profile than increased
BMI
The new international Diabetes Federation (IDF)
definition
According to the new IDF definition , for a person to be defined as having the
metabolic syndrome he/she must have :
Central Obesity ( defined as waist circumference * with ethnicity specific
values )
plus any two of the following four factors :
Raised
triglycerides
 150 mg/dL (1.7 mmol/L )
or specific treatment for this lipid abnormality .
Reduced HDL
Cholesterol
 40 mg/dl ( 1.03 mmol/L ) in males
50 mg/dL (1.29 mmol/L) in females
 or specific treatment for this lipid abnormality
Raised blood
pressure
Systolic BP 130 or diastolic BP 85 mmHg
Or treatment of previously diagnosed hypertension
Raised fasting
plasma glucose
( FPG) 100 mg/dL (5.6 mmol/L)
or previously diagnosed type 2 diabetes
Diabetes Mellitus and its state of
control and complications in the
MENA Region
Fasting Hyperglycemia
- Controlled (< 120 mg/dl )
- Uncontrolled
= 19.8 %
= 80.2 %
----------------------------------
Hyperglycemic 121-150 mg/dl
= 15.6 %
Marked hyperglycemia
-200 = 31.3 %
Severe hyperglycemia
-220 = 12.5 %
Very severe hyperglycemia > 220 = 20.8 %
Hyperglycemia
Fasting
20.80%
12.50%
> 220
200-220
151-200
31.30%
121-150
-120
15.60%
19.80%
120 mg/dl
Post Prandial Hyperglycemia
- Controlled < 160 mg/dl
= 13.5 %
- Accepted 161-180 mg/dl
= 7.9 %
Total
= 21.4 %
- Uncontrolled ( >180 mg/dl )
= 78.6 %
* Moderate
-220 mg/dl = 17.4 %
* Severe
- 260 mg/dl = 16.0 %
* Very Severe > 260 mg/dl = 45.2 %
Hyperglycemia
Post Prandial
45.20%
> 260
220-260
180-220
160-180
<160
16%
17.40%
7.90%
13.50%
180 mg/dl
Diastolic Blood Pressure
0.70%
4.50%
12.10%
18.10%
80 mm Hg
> 120
110
64.60
%
100
90
< 80
Systolic Blood Pressure
0.50%
2.80%
20.70%
22.30%
130 mm Hg
>200
200
180
150
< 130
53.70%
Lipid Control
Serum Cholesterol
10.40%
33.20%
200 mg
>250
201-250
-200
56.40%
Lipid Control
Serum Triglycerides
7.20%
9.10%
33.30%
150 mg
> 250
201-250
151-200
-150
50.40%
Colum n
1
Obesity as a Risk Factor for Hyperglycemia ,
Hypertension and Hyperlipidemia
Obesity as BMI group
Syst. B.P. > 150 mm Hg
(A)
< 24
8.7 %
(B)
(C)
24-30
> 30
20.5 % * 30.6 % *
Diast. B.P. > 80 mm Hg
17.1 %
32.9 % * 41.5 % *
S. Cholest. > 200 mg/dL
19.7 %
24.5 % * 50.4 % *
S. Triglycerides
>150mg/dL
23.5 %
22.6 % 54.9 % *
Fasting
Bl.Gluc.>120mg/dL
72.3 %
73.8 %
N.B. (%) percentage of patients above the acceptable levels
80.0 %
, (*) Significant
Cardiac Complications
25.00%
21.80%
20.00%
15.00%
15.00%
10.00%
7.90%
5.00%
0.00%
Angina
ECG+ve
H.F-Arryth
Retinopathy (in 1173 patients )
- Free
- Back ground
- Proliferative
68.9 %
22.6 %
9.5 %
Retinopathy
9.5%
22.6 %
Free
B.ground
Prolif.
68.9 %
Retinopathy in correlation with
Duration of DM
100%
80%
60%
40%
20%
0%
1
3
6
Free
9
Non-Prol.
12
15
Prol.
>15
Ankle reflex and Duration of DM
l
80
70
60
%
50
40
30
20
10
0
<1
-3
-6
-9
-12 -15 -18 -21 -24 >24
Duration /year
Frequency of Foot Complications
25.00%
22.00%
20.00%
15.00%
10.00%
9.70%
6.80%
5.00%
3.00%
1.00%
0.00%
Fungus
Isch
Ulcers
Ampt.
Deform.
Prevalence of foot complications
1- Fungus infection
2- Foot ulcers
3- Evident Ischaemic changes
4- Amputations
5- Deformities
= 22.0 %
= 6.8 %
= 9.7 %
= 3.0 %
= 1.0 %
Diabetes Keto Acidosis (DKA)
- Occurrence of DKA episodes in
= 12.2 %.
-------------------------------------------------------------------- The mean age in patients who developed DKA
= 42.5 years
- The mean age in patients who never developed
DKA
= 53.1 years
Hypoglycemia
- Occurrence of Hypoglycemic episodes in = 20.5%
------------------------------------------------------------------------ The mean age of patients who developed
hypoglycemic episodes at any time = 50.8 years
- The mean age of patients who did not experience
hypoglyceamic episodes
= 52.1 years
Fertility and Abortions
Abortions : 21.5%
Fertility : 3.6 ch/m
labour
Abortion
The Socio economic
Burden
Middle East Countries- economic status
per capitum incomes :
High
Kuwait
Emirates
Qatar
Bahrain
Oman
Saudi Arabia
Libya
>5,000 US $
Middle
(Iraq)
Iran
Low
Syria
Jordan
Tunisia
Morocco
Egypt
Yemen
Sudan
< 2,000 US $
Mean Health Expenditure /person
with diabetes in different regions
ID
2000
1561
1500
1188
1000
684
625
514
180 233
500
EU
R
NA
P
W
EN
A
SA
C
A
M
SE
A
Af
r
ic
a
0
MENA Countries according to The Mean Health
Expenditure per person with diabetes in ID
(international Dollar) : Diabetes Atlas, 3rd Ed.
> 200
Afghanistan 56
Iraq
72
Pakistan
99
Sudan
103
Yemen
110
Syria
185
200-600
Alger
Morocco
Egypt
Libya
273
285
286
384
600- 1000
> 1000
Oman
614
Tunisia
637
Jordan
711
Iran
744
Kuwait
806
Saudi Arabia 891
Emirates
929
Bahrain 1047
Lebanon 1050
Qatar
1198
Hospital Treatment 2001 Cost /Day
(Egyptian Study )
400%
354%
350%
346%
300%
250%
200%
150%
100%
100%
120.80%
50%
0%
DM
+CVD
+R.F.
+Diab. Foot
Distribution of Hospital Cost
55%
Medicine
& Supp.
45%
Basic
( Food : 5%
H.C.Team 11%
Others: 29%)
Year Cost / percapit. Burden for Human Insulin (40 u /d)
8.85%
EGYPT
1.9%
QATAR
3.1%
SAUDI ARABIA
Cost Burden of Oral Treatment related to Percapitum
4.2%
29.9%
EGYPT
QATAR
8.4%
SAUDI ARABIA
To promote diabetes care, prevention and a cure worldwide
What are The IDF Goals ?
1. Global Advocacy
2. To raise Global Awareness
3. Promote appropriate Diabetes Care &
Prevention
4. Encourage finding a Cure
For improving Diabetes Care
and Prevention , Education
of Health Care Providers should
consider expertise in both:
I- Clinical Diabetes ,
II- Educations skills
and
The Way to a National
Diabetes Program
Minimal requirements :
1- Insulin and medications availability ( affordable)
2- Primary centers for diagnosis and care
3- wide distribution of services allover the country
4- Basic requirements to manage complications
5- Education : knowledge & skills to patients –
Public orientation
6- National basic studies in epidemiology and
socioeconomics .
7- Care for Diabetes in School children
8- Care for diabetes in pregnancy
Potential Adverse Factors
1- Economic :Poor Financial Res. /per capit. /
Government expenditure/ House-hold
expend. with High Prev. of diab.
2- Demographic Extensive areas with poor
communications . High population density
3- Social : Illiteracy- Misconceptions – adverse
habits and traditions .
WHO
IDF
National
Institute
Government
Parliament
NGO
Ministry
of Health
Medical Group
Family
Patient
Work- school
Friends
Pharmaceutical
industries
Society
MEDIA
Syndicate
Physician
Nurse
Dietitian
Foot Care
Pharmacist
Laboratory
In Developing a National Diabetes
Programme :
1- Consider the specific needs in the country
and available resources to decide priorities
2 - Define the role to be played by each one
of the constituents of the community , and
Identify Champions for projects .
3- Seek partnerships with :
WHO , Twining ,WDF , Rotary , etc..
Obligations of Different Parties
The Government ( Ministry of Health)
1- Increase Investments in Health/Diabetes
2- provide Minimal Diabetes Care in Clinics & Hospitals
3- Insure Insulin & Medications Availability
4- provide Education :Patient, Health Care Team and
Public
5- Coordinate with Health Care Syndicates
6- Coordinate with NGOs
7- attract International Aid programmes
8- promote National Research ( epidemiol.-socioeconomic)
Parliament (Legislation)
1- Budget planning to improve diabetes Care
2- Taxation Exemption for insulin & medical requirements
3- Put rules and regulations for NGO activities
4- Maintain and guard Patients’ Human Rights
( anti discrimination, working , children, women ,
elderly …etc)
5- Health Insurance Laws
The Non-Governmental Organizations
(NGOs )
1- Advocacy
2- Education Programs for :
-Patients and Families
-Health Care Team
-Community at large
3 - Rules & Regulations
- legally recognized
- non profitable
- accountable and transparent
- coordinated & complementary to government
- no unhealthy competition, extravagance ,
business controlled ( by industries )
The Health Care Team
The Physician
1- is Leader of the HC team
2- is the Final reference for his patient’s education
3- keep harmony with others in the HC team
4- requires continuous training courses and updates
5- acquire education skills
Nurses
1- Training courses , by whom ?
2- Knowledge + skills & attitude
3- skills in education
4- keep Team work
5- Continuous education , scientific meetings and workshops
Diabetes Care for Special Groups
School Children
- Registration at national level
- Individual records in schools
- basic equipments to manage emergencies
- Education courses to school attendants.
- protecting special rights : play- recreation treatment .non discrimination …etc
Mothers with Diabetes of Pregnancy
- Screening for diabetes of pregnancy
- Protocols for management of GD
- Care for the N.B.
- After-labour follow-up of mothers
The National Diabetes Registry
- essential as source of information for planning public
services
- Central location
- paper or computer recordings
- contains individual patient data
- complemented by local & peripheral registries
(in schools - work – Health insurance, etc )
- network connections for exchange information
Diabetes Screening Programmes
- Specifically to high risk groups
- By central planning and organization
- ensure unified criteria for diagnosis
- Screening for early detection of complications :
- Sending study groups to remote areas .
International Relations
The International Diabetes Federation
1- get moral support from IDF to National Associations
& programs
2- use as source of information & educational material
3- Benefit from IDF Task forces’ activities and
programs
4- Benefit from WDD events
The WHO
1- Government / collaborative programmes for
promotion of diabetes Care
2- NGO : collaboration in promoting diabetes
care through training & education
programmes
The Patient Obligations
1- Take active role: seek to be educated
2- follow proper life style
3- comply
4- not to accept misconceptions and deceptive propaganda
Thank You
Bibliotheca Alexandrina on WDD