POST-IDF HIGHLIGHTS Diabetes: Epidemie of the 21st century!.. M.Chana( M orocco )
Diabetes as a Global Health Problem The IDF meets the Challenge By
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Transcript of Diabetes as a Global Health Problem The IDF meets the Challenge By
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Diabetes as a Global Diabetes as a Global Health ProblemHealth Problem
The IDF meets the The IDF meets the ChallengeChallenge
ByBy
Prof. Morsi ArabProf. Morsi Arab
IDF Chairman MENA RegionIDF Chairman MENA Region
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MENA
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Reported Incidence of Type1 Diabetes at the MENA Region per 100.000 population under 15 yrs ( Diabetes Atlas 2006)
• Afghanistan 1.2• Algeria 8.6 • Bahrain 2.5• Egypt 8.0• Iran 3.7• Iraq 3.7• Jordan 3.2• Kuwait 22.3• Lebanon 3.2• Libya 9.0• Morocco 8.6• Palestine 3.2• Oman 2.5• Pakistan 0.5• Qatar 11.4• Saudi Arabia 12.3• Sudan 10.1• Tunisia 7.3 • Emirates 2.5• Yemen 2.5
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�ِAt The MENA Region
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 (
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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
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MENA
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30.5
20.5
14.3
13
9.3
6.3
6.1
0 5 10 15 20 25 30 35 %
age
gro
up
sThe pyramidal structure of the
Egyptian population
>60
-60
-50
-40
-30
-20
-10
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Prevelance of DM in whole Egypt in Different Age Groups
0.62 0.80
3.08
8.25
12.04
15.06
0
2
4
6
8
10
12
14
16
% p
op
ula
tio
n
Age Group 10 20 30 40 50 60
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0
5
10
15
20
25P
erc
en
t
20 30 40 50 60 >60
Age
Diabetes Prevelance & Age Groups
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Western desert
Eastern desert
Saini
Nubia
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14.7% 14.3%
5.6%
8.5%
2.0%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
U UN RN RA RD
Prevelance of DM among age group ( 40 - ) in different communities
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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
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“Obesity” is always involved , or associated with all elements of the
Metabolic Syndrome:
But Which type of Obesity?
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“Abdominal Obesity “ as measured by waist
circumference is more indicative of the
Metabolic Syndrome profile than increased BMI
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The new international Diabetes Federation (IDF) definitionAccording 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
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Diabetes Mellitus and its state of control and complications in the
MENA Region
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Fasting Hyperglycemia
- Controlled (> 120 mg/dl ) = 19.8%
- Uncontrolled = 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 %
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19.80%
15.60%
31.30%
12.50%
20.80%
> 220
200-220
151-200
121-150
-120
120 mg/dl
Hyperglycemia Fasting
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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%
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Post Prandial
13.50%
7.90%
17.40%
16%
45.20%
> 260 220-260180-220160-180<160
180 mg/dl
Hyperglycemia
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Diastolic Blood Pressure
64.60%
18.10%
12.10%
4.50%
0.70%
> 120
110
100
90
> 80
80 mm Hg
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Systolic Blood Pressure
53.70%
22.30%
20.70%
2.80%
>200200180150< 130
130 mm Hg
0.50%
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56.40%
33.20%
10.40%
>250
201-250
-200
Lipid Control
Serum Cholesterol
200 mg
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Lipid ControlSerum Triglycerides
50.40%
33.30%
9.10%
7.20%
> 250
201-250
151-200
-150
Column1
150 mg
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Obesity as BMI group )A (
>24
)B(
24-30
)C (
>30
Syst. B.P. > 150 mm Hg 8.7% 20.5* % 30.6* %
Diast. B.P. > 80 mm Hg 17.1% 32.9* % 41.5* %
S. Cholest. > 200 mg/dL19.7% 24.5* % 50.4* %
S. Triglycerides >150mg/dL
23.5% 22.6% 54.9* %
Fasting Bl.Gluc.>120mg/dL
72.3% 73.8% 80.0%
N.B. (%) percentage of patients above the acceptable levels , (*) Significant
Obesity as a Risk Factor for Hyperglycemia , Hypertension and Hyperlipidemia
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15.00%
7.90%
21.80%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Angina ECG+ve H.F-Arryth
Cardiac Complications
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Retinopathy (in 1173 patients ) - Free 68.9 % - Back ground 22.6 %
- Proliferative 9.5%
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Retinopathy
22.6 %
9.5%
68.9 %
Free
B.ground
Prolif.
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Retinopathy in correlation with Duration of DM
0%
20%
40%
60%
80%
100%
1 3 6 9 12 15 >15
Free Non-Prol. Prol.
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Ankle reflex and Duration of DM
0
10
20
30
40
50
60
70
80
>1 -3 -6 -9 -12 -15 -18 -21 -24 >24
Duration /year
%
l
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22.00%
9.70%
6.80%
3.00%
1.00%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Fungus Isch Ulcers Ampt. Deform.
Frequency of Foot Complications
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Prevalence of foot complications
1 -Fungus infection = 22.0%
2 -Foot ulcers = 6.8%
3 -Evident Ischaemic changes = 9.7%
4 -Amputations = 3.0%
5 -Deformities = 1.0%
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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
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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
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labour Abortion
Fertility and Abortions
Abortions : 21.5%
Fertility : 3.6 ch/m
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The Socio economic Burden
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Middle East Countries- economic statusper capitum incomes:
High Kuwait EmiratesQatarBahrainOmanSaudi ArabiaLibya
Low SyriaJordanTunisiaMoroccoEgyptYemenSudan
Middle
(Iraq)Iran
>5,000 US $
> 2,000 US $
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Mean Health Expenditure /person with diabetes in different regions
180 233514 625 684
11881561
0
500
1000
1500
2000ID
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>200200-600600 -1000 >1000
Afghanistan 56
Iraq 72
Pakistan 99
Sudan 103
Yemen 110
Syria 185
Alger 273
Morocco 285
Egypt 286
Libya 384
Oman 614
Tunisia 637
Jordan 711
Iran 744
Kuwait 806
Saudi Arabia 891
Emirates 929
Bahrain 1047
Lebanon 1050
Qatar 1198
MENA Countries according to The Mean Health Expenditure per person with diabetes in ID (international Dollar) : Diabetes Atlas, 3rd Ed.
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100%120.80%
354% 346%
0%
50%
100%
150%
200%
250%
300%
350%
400%
DM +CVD +R.F. +Diab. Foot
Hospital Treatment 2001 Cost /Day
(Egyptian Study )
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55% Medicine & Supp.
45% Basic( Food : 5%
H.C.Team 11%
Others: 29%)
Distribution of Hospital Cost
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8.85%
EGYPT
1.9%
QATAR
3.1%
SAUDI ARABIA
Year Cost / percapit. Burden for Human Insulin (40 u /d)
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EGYPT
29.9%
Cost Burden of Oral Treatment related to Percapitum
QATAR
4.2%
8.4%
SAUDI ARABIA
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To promote diabetes care, prevention and a cure worldwide
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What are The IDF Goals? 1 .Global Advocacy
2 .To raise Global Awareness
3 .Promote appropriate Diabetes Care & Prevention
4 .Encourage finding a Cure
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Objective 4 attained!
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For improving Diabetes Care and Prevention , Education of Health Care Providers should consider expertise in both: I- Clinical Diabetes , and
II- Educations skills
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The Way to a National Diabetes Program
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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
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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.
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Patient
IDF
NGO
Family
Pharmaceutical industries
WHO
Society
PhysicianNurseDietitianFoot CarePharmacistLaboratory
Medical Group
Work- schoolFriends
MEDIA
Ministry of Health
Government
ParliamentSyndicate
National Institute
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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..
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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)
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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
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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 )
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The Health Care TeamThe 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
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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
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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
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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
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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.
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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
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The WHO
1- Government / collaborative programmes for promotion of diabetes Care2- NGO : collaboration in promoting diabetes care through training & education programmes
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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
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Thank You
Bibliotheca Alexandrina on WDD