Diabetes- A Major Public Diabetes- A Major Public Health ProblemHealth Problem

Dr. Nayyar Raza KazmiDr. Nayyar Raza Kazmi

Diabetes mellitus is a chronic Diabetes mellitus is a chronic condition that characterised by condition that characterised by raised plasma glucose levels. raised plasma glucose levels. 

Diabetes, results from the body’s Diabetes, results from the body’s inability to produce or use inability to produce or use insulin properly, resulting in high insulin properly, resulting in high levels of blood sugar. levels of blood sugar. 

• Type 2 diabetes is caused by a Type 2 diabetes is caused by a combination of insulin resistance combination of insulin resistance and some degree of insulin and some degree of insulin deficiency. deficiency.

• Type 1, the body produces no Type 1, the body produces no insulin. More than 80% of insulin. More than 80% of recognised diabetes is Type 2 and recognised diabetes is Type 2 and most of the remainder is Type 1.most of the remainder is Type 1.

• WHO defines Diabetes as Fasting WHO defines Diabetes as Fasting Blood Glucose more than 126 mg/dL Blood Glucose more than 126 mg/dL on one single occasion on one single occasion

OROR

• Random Blood Glucose of 200mg/dL Random Blood Glucose of 200mg/dL or more on 2 and/or more occasions.or more on 2 and/or more occasions.

Magnitude of the ProblemMagnitude of the Problem

0

50

100

150

200

250

300

millions

199520002025

• The number of The number of people with people with diabetes will diabetes will nearly double nearly double within the first within the first quarter of this quarter of this millennium.millennium.

World Health Report, World Health Report, 1997; Geneva: WHO.1997; Geneva: WHO.

WHO estimate: prevalence of diabetes for all age- WHO estimate: prevalence of diabetes for all age- groups worldwide was estimated to be 2.8% in groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. 2000 and 4.4% in 2030.

• Estimated rise in number from 171 million in Estimated rise in number from 171 million in 2000 to 366 million in 2030. 2000 to 366 million in 2030.

• 150% rise in developing countries by 2030. 150% rise in developing countries by 2030. • Number of deaths attributed to diabetes was Number of deaths attributed to diabetes was

previously estimated at just over 800,000.previously estimated at just over 800,000.

• Prevalence in Pakistan approx 4.2%Prevalence in Pakistan approx 4.2%

• Highest in Urban Mohajirs (5.7%, Highest in Urban Mohajirs (5.7%, 9.7%)9.7%)

• Punjabis (4.6%, 7.2%)Punjabis (4.6%, 7.2%)

• Sindhis (5.1%, 4.8%)Sindhis (5.1%, 4.8%)

• Pushtoons (3.0%, 3.8%)Pushtoons (3.0%, 3.8%)

• Baluchs (2.9%, 2.6%)Baluchs (2.9%, 2.6%)

Why TypeII Diabetis Prevlance Why TypeII Diabetis Prevlance is Increasingis Increasing

• Aging of the population.Aging of the population.

• Increased incidence due to Increased incidence due to urbanization especially in the urbanization especially in the developing countries.developing countries.– More sedentary lifestyle.More sedentary lifestyle.– Food consumption patterns, more Food consumption patterns, more

foods with high fat content and foods with high fat content and more refined carbohydrates.more refined carbohydrates.

The Cost of DiabetesThe Cost of Diabetes

• Direct costs:Direct costs:– Direct costs to individuals and their families Direct costs to individuals and their families

include medical care, drugs, insulin and other include medical care, drugs, insulin and other suppliessupplies

– Direct costs to the healthcare sector include Direct costs to the healthcare sector include hospital services, physician services, …hospital services, physician services, …

– Overall, direct health care costs of diabetes range Overall, direct health care costs of diabetes range from 2.5% to 15% annual health care budgets, from 2.5% to 15% annual health care budgets, depending on local diabetes prevalence and the depending on local diabetes prevalence and the sophistication of the treatment available.sophistication of the treatment available.

The Cost of DiabetesThe Cost of Diabetes

• Indirect costs: Indirect costs: – Sickness, absence, disability, premature Sickness, absence, disability, premature

retirement or premature mortality can retirement or premature mortality can cause loss of productivity. cause loss of productivity.

– Estimating the cost to society of this loss Estimating the cost to society of this loss of productivity is not easy. Pain, anxiety, of productivity is not easy. Pain, anxiety, inconvenience and other factors which inconvenience and other factors which decrease quality of life are intangible decrease quality of life are intangible costs, which are just as heavy.costs, which are just as heavy.

Facts on Prevention DiabetesFacts on Prevention Diabetes

The heavy social and economic costs The heavy social and economic costs of type 2 diabetes of type 2 diabetes

(including its role in other diseases,(including its role in other diseases, such as heart diseasesuch as heart disease

and stroke) mean that primary and stroke) mean that primary prevention must be a priority.prevention must be a priority.

Facts on Prevention of Facts on Prevention of DiabetesDiabetes

pre-diabetes can prevent the pre-diabetes can prevent the development of type 2 diabetes development of type 2 diabetes by making changes in their by making changes in their lifestyle. lifestyle.

Effective prevention also means Effective prevention also means more cost-effective healthcare. more cost-effective healthcare.

Facts on Prevention of Facts on Prevention of DiabetesDiabetes

• Primary prevention protects Primary prevention protects susceptible individuals from susceptible individuals from developing diabetes. It has an developing diabetes. It has an impact by reducing or delaying impact by reducing or delaying both the need for diabetes care both the need for diabetes care and the need to treat diabetes and the need to treat diabetes complications.complications.

Facts on Prevention of Facts on Prevention of DiabetesDiabetes

• Secondary prevention includes Secondary prevention includes early detection, prevention and early detection, prevention and treatment. Appropriate action treatment. Appropriate action taken at the right time is taken at the right time is beneficial in terms of quality of beneficial in terms of quality of life, and is cost-effective, life, and is cost-effective, especially if it can prevent especially if it can prevent hospital admissionhospital admission

Primary prevention Primary prevention

Primary prevention

Weight Weight LossLoss Physical Physical

ActivityActivity

Stop Stop Smoking Smoking

Primary preventionPrimary prevention• Lifestyle Changes Can Prevent Lifestyle Changes Can Prevent

DiabetesDiabetes Weight Loss Is Accompanied by Weight Loss Is Accompanied by Considerable Lowering of the Risk of Considerable Lowering of the Risk of DiabetesDiabetes

• Physical Activity and Diabetes Physical Activity and Diabetes PreventionPrevention

• Smoking Predisposes to Type 2 Smoking Predisposes to Type 2 DiabetesDiabetes

Taking Action to Prevent Taking Action to Prevent DiabetesDiabetes

Change will come more easily if Change will come more easily if everyone is involved.everyone is involved.

Major issues to considerMajor issues to consider

• Policy and Advocacy at National levelPolicy and Advocacy at National level

• Capacity BuildingCapacity Building

• ResourcesResources

• Monitoring and EvaluationMonitoring and Evaluation

• Diabetes registries and Information Diabetes registries and Information SystemsSystems

Weight Loss Is Accompanied by Considerable Weight Loss Is Accompanied by Considerable Lowering of the Risk of DiabetesLowering of the Risk of Diabetes

• 1. Body-Mass Index1. Body-Mass Index: Obesity in adults is : Obesity in adults is assessed using the body-mass index (BMI assessed using the body-mass index (BMI = body weight in kg divided by the square = body weight in kg divided by the square of body height in meters) of body height in meters) The higher the The higher the body-mass index, the higher the morbidity body-mass index, the higher the morbidity and mortality risks become. and mortality risks become.

• The risk of diabetes increases 15-fold as The risk of diabetes increases 15-fold as the body-mass index rises from 23 kg/m2 the body-mass index rises from 23 kg/m2 to 35 kg/m2. to 35 kg/m2.

2. Waist Circumference2. Waist Circumference• The body-mass index does not The body-mass index does not

indicate the distribution of body fat, indicate the distribution of body fat, and waist circumference is therefore and waist circumference is therefore also used as a measure of obesity and also used as a measure of obesity and the associated health risks.the associated health risks.

Treatment of obesity will prevent Treatment of obesity will prevent illness development in individuals at illness development in individuals at risk and improve quality of life and risk and improve quality of life and prevent late complications in those prevent late complications in those already affected. already affected.

In recent years, attention has been In recent years, attention has been increasingly focused on the incidence increasingly focused on the incidence of central obesity which has been of central obesity which has been found to strongly predict risks of type found to strongly predict risks of type 2 diabetes and metabolic syndrome.2 diabetes and metabolic syndrome.

Physical Activity and Diabetes Physical Activity and Diabetes PreventionPrevention

• Physical activity decreases insulin Physical activity decreases insulin resistance and can aid in both resistance and can aid in both preventing type 2 diabetes mellitus and preventing type 2 diabetes mellitus and managing the disease.managing the disease.

• Physical activity has an insulin-like Physical activity has an insulin-like effect -- it can help lower blood sugar effect -- it can help lower blood sugar levels. levels.

• Epidemiological studies suggest that Epidemiological studies suggest that physical activity can reduce the risk of physical activity can reduce the risk of non-insulin-dependent diabetes by up to non-insulin-dependent diabetes by up to 50 percent.50 percent.

Smoking Predisposes to Type 2 Smoking Predisposes to Type 2 DiabetesDiabetes

• Studies shown correlation Studies shown correlation between smoking and the risk of between smoking and the risk of developing type 2 diabetes. developing type 2 diabetes.

– The risk is dose-dependent: the The risk is dose-dependent: the longer you smoke, the higher the longer you smoke, the higher the risk.risk.

RecommendationsRecommendations

Change will come more easily if Change will come more easily if everyone is involved.everyone is involved.

• prevention diabetes can be on prevention diabetes can be on different levels; individuals, different levels; individuals, community, local government community, local government

and national levelsand national levels..

RecommendationsRecommendations

• The government should work to The government should work to reduce health inequality and reduce health inequality and improve the environment factor by improve the environment factor by improving the deprived areas and improving the deprived areas and controlling safety and making the controlling safety and making the streets safe for walking or cycling streets safe for walking or cycling to school or the workplace, to school or the workplace, promoting and improving access to promoting and improving access to sport and leisure facilities, as well sport and leisure facilities, as well as encouraging physical activityas encouraging physical activity

• Parents of overweight children should Parents of overweight children should be helped to take responsibility and be helped to take responsibility and encourage healthy eating and encourage healthy eating and physical activity. physical activity.

• Anti- smoking behaviour should be Anti- smoking behaviour should be promoted by implementing legal promoted by implementing legal action.action.