Welcome Introduction

Type 2 diabetes and the status of

management of diabetes in Vietnam

Hoang Kim Uoc, MD. PhD.Hospital of Endocrinology

I. The status of type 2 diabetes in viet nam

The summary of the study design (2002 national survey):

The study was carried out in 9022 subjects aged 30 - 64 in four areas including mountain, costal and middle land, and city areas over the whole country;

The subjects were random selected; Case defined as FBG >= 7 mmol/L or/and 2HBG

>= 11.1 mmol/L or/and diagnosed and treated by doctor before;

Diabetes, IFG, and IGT rates are adjusted by age and population structure and distribution.

2.1 2.1

3.12.7

2.52.2

5.5

4.4

3.5

2.7

0

1

2

3

4

5

6

Mountain DELTA C & ML CITIE TOTAL

Crude Rate

Adjusted Rate

the prevalence of type 2 dM by areas and over the whole country

the prevalence of IFG and IGT by area and over the whole country

2.2

7.1

1.4

7.0

2.4

8.3

1.8

6.5

1.9

7.3

0

1

2

3

4

5

6

7

8

9

MOUNTAIN DELTA C & ML CITIES TOTAL

IFG AdjustedIGT Adjusted

6,14,9

4,6

2,7

1,00,6

10,1

12,5

11,4

10,1

7,57,9

6,1

3,9

0

2

4

6

8

10

12

14

30-34 35-39 40-44 45-49 50-54 55-59 60-64

DM

IGT

P < 0.001

Diabetes and IGT distributed by age

3.2 3.7

5.9

8.9

0

2

4

6

8

10

MALE FEMALE

DMIGT

P = 0,156

P < 0,0005

diabetes and IGT distributed by gender

18.616.8

12

9.9

2.6

0

2

4

6

810

12

14

16

18

20

BMI >= 23 Hypertension Inactive large waist FHDM

the distribution of some main risk factors

The subjects distributed by risk factor frequency

36.139.3 37.8

57.4

40.8

11.8

14.913.8

31.3

16.3

3

6.1

4.6

13.2

6.0

0

10

20

30

40

50

60

RF 1+ RF 2+ RF 3+

MOUNTAIN DELTA

C & ML CITIES

TOTAL

1.565 1.668 1.751

2.341 2.373

2.958

1

2

3

4

5

BMI >=23 INACTIVE Large waist Hypertension FHDM Age>= 45

P = 0,002

P < 0,0005

P < 0,0005

P = 0,0005

P < 0,0005P < 0,0005

diabetes risk for an individual risk factor

Known DM

35.5%

Unknown DM64.5%

II. The status of dM management in viet nam

The prevalence of undiagnosed diabetes

7.9% 4.9% 1.4%

85.8%

W/all symptoms Routine check

For another examination Complications

Condition to detect diabetes

The concentrations of BG, HbA1C in new cases of diabetes (n =

238)

10.3

13.6

8.6

17.517.8

21.3

15.3

26.1

13.5

11.19.27.6

0

5

10

15

20

25

30

P25% P50% P75% P95%

FBG (mmol/L) PMBG(mmol/L) HbA1C (%)

17.3

33.4

53.457.2

1.2 2.98.9

14.316.1

30.5

42.944.5

0

10

20

30

40

50

60

70

< 1 year 1 - 5 year > 5 - 10 year > 10 year

TOTALPREPROPRO

Diabetes retinopathy distributed by duration of the disease

18.1

26.9

15.8

11.6

7.2

3.0 3.93.5

0

5

10

15

20

25

30

Newdiagnosed group ALL

Any type Microalbumin niÖu

Macroalbulin niÖu Kidney failure

* Kidney Failure from 1 to 4

Diabetes nephropathy in new cases of diabetes

70.9

29.1

2.9

0

10

20

30

40

50

60

70

80

Diet + Exercise Diet + Exersice +Med

Medication

Diabetes Regimen applied in community

Parameter Optimal Fair Poor

FBG 29.1% 10.7% 60.2%

PMBG 37.7% 5.7% 56.6%

Blood Pressure . . 54.3%

Quality management of diabetes in community

12.95.9

17.9

6.7

69.2

87.4

0%

20%

40%

60%

80%

100%

FBG HbA1C

OptimalFairPoor

Quality management of diabetes in provinces

1. ObjectivesThe general objective of the national project is to reduce incidence, complications, and mortality caused by diabetes, specific objectives by 2010 as following:

Raising awareness of community on diabetes risk factors up to 70%

Reducing the rate of un-known diabetes in community down to 60%

Managing 50% of known diabetics, in which 50% of them are managed optimally (blood glucose and risk factor of complications).

The project for prevention and control of diabetes mellitus in viet nam

2.2. SolutionsSolutions Solution group in order to reduce incidence of Solution group in order to reduce incidence of

diabetesdiabetes Communication and Education on risk factorsCommunication and Education on risk factors Active prevention for high risk group at Active prevention for high risk group at

diabetes;diabetes; Setting up a healthy lifestyle to prevent Setting up a healthy lifestyle to prevent

diabetes.diabetes.

Solution group in order to prevent or delay diabetic Solution group in order to prevent or delay diabetic complications:complications:

Early detection of diabetes among high-risk Early detection of diabetes among high-risk people at diabetes in hospital and communitypeople at diabetes in hospital and community

Early and comprehensive management of Early and comprehensive management of diabetesdiabetes

Education of self-management for diabetic Education of self-management for diabetic patients.patients.

The project for prevention and control of diabetes mellitus in viet nam

2.2. SolutionsSolutions (next) (next) Solution on policy, net-work in order to manage Solution on policy, net-work in order to manage

diabetes efficiently and equally with reasonable cost diabetes efficiently and equally with reasonable cost in the world country:in the world country:

Endocrinology Centre net-work: Endocrinology Centre net-work: PreventionPrevention Early detectionEarly detection Management of diabetics with mild Management of diabetics with mild

complication or without complicationscomplication or without complications End. Department net-work in provincial general End. Department net-work in provincial general

hospital:hospital: Endocrinology emergencyEndocrinology emergency Management of diabetes.Management of diabetes.

The project for prevention and control of diabetes mellitus in viet nam

Discussion

What is the clinical need in the early type 2 diabetes paradigm in Vietnam?