Global Diabetes

Project HOPE: Addressing Diabetes Around the World

Charlotte Block, MS, RDProgram Officer – Chronic DiseaseProject HOPE

CORE Group Spring MeetingMay 12th, 2011Baltimore, MD

Agenda – Global Diabetes

• The numbers

• The causes

• The impact

• The challenges

• The approaches

• The future

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Global Diabetes Burden: Large and growing

Mexico6.8 M (10.1%)

Brazil7.6 M (6%)

China43.2 M (4.5%)

India50.8 M (7.1%)

Egypt4.8 M

(10.4%)

Kenya0.5 M (2.8%)

South Africa1.3M (4.5%)

UAE0.4 M (12.2%)

Oman0.2 M (11.1%)

Indonesia7 M (4.6%)

USA26.8 M (12.3%)

UK2.1 M (4.9%)

Australia1 M (7.2%)

Japan7 M (7.3%)

Canada2.9 M (11.6%)

Russia9.6 M (9%)

Researched country Comparison country

Source: IDF Diabetes Atlas 2010, MedMarket Diligence, LLC

Diabetes and NCD Need

Global Diabetes Epidemic 2009

Top 10: Number of People with Diabetes 2010 and projected 2030

1 China 92.4

2. India 50.8

Major Causes?

Urbanization:• Transportation changes

• Culture shift: Western diet, processed foods, sedentary activities

• Household income increases

• Historic perceptions: more is better!

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Public Health and Economic Impact: A Cause for Action

Health systems lack capacity and processes to treat chronic conditions (acute-focused)

Population incidence for diabetes grows 5.5% per year without behavior-change interventions

Currently high-risk or undiagnosed populations develop late-stage complications before detection

Diagnosed patients experience poor diabetes management due to lack of human and intellectual capital

Specialty Care BurdenPreventable conditions develop into high-cost and complex burdens on

primary-tertiary health systems

High-Cost Medical TreatmentGrowth in high-cost treatments for

amputations, blindness, renal failure, and co-morbidities such as CVD

Lack of Population ProductivityDiabetes caused 6.8% of all deaths in 2010 and will increase 5.5-12%

per year in some regions

Governments lack effective programs and policies to prevent increased incidence and severity of diabetes

Public Health Impact Economic Impact

Prevalence

438 M People

Global Spend

$561 billion

Source: IDF World Diabetes Atlas – Economic Impacts of Diabetes

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Saving Lives: Understanding the Many Faces of Diabetes

Type 1, 8 years old Family bankruptcy due to

health costs No treatment access Removed from school

Type 2, 45 years old Limited exercise options CVD/bp co-morbidities Prominent cultural foods Fate-driven beliefs

Type 2, 22 years old Malnourished TB dual burden Limited access to funds

for healthy foods

“Insulin is like air to me; I need it to live”

“Diabetes is my fate, so why should I change?”

“I’d rather have HIV than have diabetes”

Diabetes - Global Health Crisis• Doubles risk of CVD and stroke

• Leading cause of renal failure

• 10x lower limb amputations

• Leading cause of blindness/impairment

• 2–3x the health-care resources or 15% of national health care budgets

• TB risk 3x higher

What Works?

• Health professional development:• Clinical• Education• Communication

• Patient–centered care• Lifestyle modifications• Peer/family support• Community awareness and

mobilization

Diabetes Education

Diabetes Educators help patients:

– Make informed health decisions– Adopt behavioural changes– Address psychosocial issues

So patients can manage their diabetes-related health to the best of their ability

Project HOPE: Diabetes Programs

Mexico2001-present

India2007-present

China1996-presentNew Mexico, USA

2010- present

S. Africa pending

Nicaragua2010 - present

Qingdao

Chengdu

Xi’an

Beijing

Guangzhou

Hangzhou

Shanghai Ruijin

Shanghai Huashan

Harbin

Nanjing

China Diabetes Program (1996-Present)

• Rural and Urban Training Centers• Trained >40,000 health care providers• Reaching >170,000 patients and families• MoH partnership -> National Standards

• “Healthy Habits for a Healthy Weight”

• Expanded to New Mexico & India

•“Diabesity” – targeting 3rd graders

• Holistic approach – school & home

• Health vs illness focused

• Promotes 3 healthy habits

Mexico (2001 – Present)

Layers of Obesity

Master Trainer/Centers of Excellence• Distance learning • Launching Diabetes Educator profession • Based on IDF diabetes ed.• 10 Diabetes Centers country-wide

India Diabetes Educator Project (IDEP)

New Mexico – HABITS for LIFE

• Targeting health disparities using Telehealth• US/Mexico rural border communities• Prevention, Screening & Access to Specialty Care• HW training to build clinical & educational capacity

Gestational Diabetes

• Pilot project in Nicaragua & Mexico

• Training government health workers

• Trainees screen and educate pregnant patient groups at health centers.

Plans for the Future…

• Integrated, community-based care - Johannesburg• Workplace health programs

• Children with Type 1 diabetes• Expansion:

– Type 2 / Diabesity – Children

– Gestational diabetes

– Peer education/support

For more information:

Charlotte Block, MS, RDProgram Officer - Chronic Disease/Nutritioncblock@projecthope.orgwww.projecthope.org

Thank You!

Special thanks to consultant Emily Ewell