Transcript Diabetes as a Global Health Problem

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