Diabetes and How it Is Affecting Regional and Global

Health with a Focus on Myanmar

Lions Clubs International IAG Mission

Myanmar, 2013Part I

1

What is Diabetes?

•Diabetes mellitus is a condition that occurs when the body can't use glucose (a type of sugar) normally. Glucose is the main source of energy for the body's cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas. Insulin helps glucose enter the cells.

•In diabetes, the pancreas does not make enough insulin (type 1 diabetes) or the body can't respond normally to the insulin that is made (type 2 diabetes). This causes glucose levels in the blood to rise, leading to symptoms such as increased urination, extreme thirst, and unexplained weight loss to mention a few.

2

Diabetes Association Diabetes and Outreach Pilot Outreach

Pilot ProgramDiabetes is a Global Problem:•IDF estimates 366.2 million people worldwide have diabetes. •Projected to increase to 551.8 million by 2030 or 9.9% of adults, which equates to approximately three more people with diabetes every 10 seconds. •The number of people with diabetes is increasing in every country and disproportionately affects the socially disadvantaged.•In 2004, an estimated 3.4 million people died from consequences of high blood sugar.•More than 80% of diabetes deaths occur in low and middle income countries.•Health systems in many of these developing countries are not equipped to meet the rising demand.

3

Diabetes is a Global Problem Cont.:

•Diabetes has become one of the major causes of premature illness and death in many countries and a leading cause of blindness, amputation and kidney failure.•IDF estimates that half of people with diabetes are undiagnosed.•WHO projects that diabetes deaths will increase by two thirds between 2008 and 2030. •4.8 million people died and more than $471 B USA spent on healthcare for diabetes in 2012.•Healthy diet, regular physical activity, maintaining a normal body weight, avoiding tobacco use and excess use of alcohol can prevent or delay the onset of type 2 diabetes

4

Education is essential:

“Access to essential education for everyone is the key to prevention and control of diabetes. In order to reduce the impact of diabetes, basic knowledge on the prevention and optimal management of diabetes must reach those with diabetes, those at risk from the disease, our healthcare provides and policy makers.”

Dr. Samlee Plianbangchang-Regional Director SEARO, November 14, 2012

5

6

In the WHO South East Asia Region, there are an estimated 81 million living with diabetes.

•Prevalence of diabetes varies between 6% to 16% among adults across countries in the Region.

•What is of concern in the Region, is that an estimated 33% to 50% of diabetes goes undiagnosed.

•Delays in diagnosis result in patients developing complications and poor outcomes, resulting in premature mortality.

Dr. Samlee Plianbangchang-WHO Regional Director, SEARO November 14, 2012

• Diabetes in the WHO South East Asia Region:

7

• Estimated proportion of deaths by cause, South-East Asia Region, 2008Total number of deaths in the Region=14.5 million (Source: WHO global Health observatory 2011 http://apps.who.int/ghodata/ )

8

Cardiovascular diseases24.9%

Injuries10.7%

Communicable diseases, maternal & perinatal conditions,

nutritional deficiencies34.7%

Chronic respiratory diseases/asthma

9.6%

Cancers7.8%

Other chronic diseases10.2%

Diabetes2.1%

• Percentage of Non Communicable Disease (NCD) deaths in population aged <60 years by cause, 2008 -NCDs claim younger lives in South-East Asia Region compared to rest of the world (Source: WHO Global Health Observatory 2011 http://apps.who.int/ghodata/ )

9

34

49

27 27

2123

31

21

1614

0

10

20

30

40

50

All NCD deaths Cancer deaths Diabetes Cardiovasculardeaths

Chronic respiratorydiseases

Cause of NCD death

Perc

enta

ge

South-East Asia RegionRest of the world

• Estimated attributable number of deaths by risk factor, South-East Asia Region, 2004 High blood pressure, high blood glucose and tobacco use are the top ranking risk factors for mortality in the Region (Source: Global Health Risk 2009, WHO)

10

0

500

1000

1500

Num

ber

of attributa

ble

death

s

(000's

)

• Prevalence of Smoking-South East Asia Region 2008 (Source: WHO Global Status Report on Non-communicable Diseases, 2010)

11

0.5 0.43.2

6.89.5

0.1

38

22

49

3330

16

32

1.3

0

20

40

60

% o

f cu

rren

t da

ily s

mok

ers

Females

Males

There are 250 million smokers and an equal number of smokeless tobacco users in the Region

• Adult average per capita consumption of pure alcohol, South-East Asia Region, 2008 (Source: WHO Global Status Report on Non-communicable Diseases, 2010; data reported by countries is adjusted for the year 2008)

12

0.170.54

4.3

2.7

0.56 0.58

2.4

0.81

7.1

0.74

0

2

4

6

8

Avera

ge P

re C

apita C

onsu

mption

(Litre

s)

• Percentage of adults with insufficient physical activity, South-East Asia Region, 2008 (Source: WHO Global Status Report on Non-communicable Diseases, 2010)

13

6.6

18

28

41

1517

33

21

2.7

13

32

37

10

14

1917

0

5

10

15

20

25

30

35

40

45

Bangladesh India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand

Pre

vale

nce (

%)

of In

suffi

cie

ntly A

ctive

FemalesMales

• Prevalence of high blood pressure (BP), South-East Asia Region, 2008 (Systolic BP≥ 140 or diastolic BP≥ 90 or on medication . Source: WHO Global Status Report on Non-communicable Diseases, 2010; prevalence rate adjusted for 2008 based on country reported risk factor surveillance data)

14

37

34

39 4037

32

40

36

4244

42

37

0

10

20

30

40

50

Bhutan India Indonesia Myanmar Sri Lanka Thailand

Pre

vale

nce

(%

) of H

igh B

P

FemalesMales

More than a third of the adult

population is affected by high blood pressure

• Percentage of adult population with raised cholesterol, South-East Asia Region, 2008 Fasting cholesterol ≥ 190 mg/dl (Source: WHO Global Status Report on Non-communicable Diseases, 2010; prevalence rate adjusted for 2008 based on country reported risk factor surveillance data)

15

31 30

38

56

32

26

33

55

0

20

40

60

Bhutan India Indonesia Thailand

Pre

vale

nce (

%)

of R

ais

ed C

hole

ste

rol

Females

Males

• Percentage of adult population overweight, South-East Asia Region, 2008 Note: Overweight=Body mass index≥ 25 kg/m2 (Source: WHO Global Status Report on Non-communicable Diseases, 2010; prevalence rate adjusted for 2008 based on country reported risk factor surveillance data)

16

7.8

24

13

25

53

24

8.9

27

37

7.6

25

10

16

30

14

9.8

17

26

0

10

20

30

40

50

60

Bangladesh Bhutan India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand

% o

f popula

tion o

verw

eig

ht

FemalesMales

Women are more likely to be overweight

• Percentage of adult population with raised glucose level, South-East Asia Region, 2008 Fasting glucose ≥126 mg/dl or on medication (Source: WHO Global Status Report on Non-communicable Diseases 2010; prevalence rate adjusted for 2008 based on country reported risk factor surveillance data)

17

9.9

13

11

7.17.5

7.1

9.38.6

7.1

9.2

12

11

6.6

7.8

6.1

9.89.3

7.3

0

2

4

6

8

10

12

14

Bang

lades

h

Bhut

anIn

dia

Indo

nesia

Maldive

s

Myanm

ar

Nepal

Sri L

anka

Thail

and

Prev

alen

ce (

%)

of R

aise

d Fa

stin

g G

luco

se L

evel

FemalesMales

NUMBER OF PEOPLE WITH DIABETESIN SEAR 2011 (MILLIONS)

WHO-Number of People with Diabetes in SEAR 2011 (millions)

18

Country Men Women Combined

Bangladesh 4.10 4.31 8.41

Bhutan 0.01 0.01 0.02

DPR Korea 0.666 0.842 1.51

India 32.50 28.76 61.26

Indonesia 3.04 4.25 7.29

Maldives 0.01 0.01 0.02

Myanmar 0.86 1.25 2.10

Nepal 0.26 0.22 0.48

Sri Lanka 0.56 0.52 1.08

Thailand 1.78 2.24 4.02

Timor Leste 0.01 0.02 0.03

Total SEAR 43.80 42.42 86.21

Diabetes in Myanmar:

•Prevalence of Diabetes in Lower Myanmaris 9% according to a Joint survey completed by Myanmar DOH & WHO, 2011.

•Findings show 11.1% in urban areas, and 7.3% in rural areas

had diabetes. Missima news, June 2011

19

• Diabetes Prevalence (Millions)WHO-2011

Age Men Females

20-29 0.007 0.009

30-39 0.031 0.044

40-49 0.075 0.113

50-59 0.120 0.168

60-69 0.130 0.153

70-79 0.098 0.092

Diabetes in Myanmar Cont.

Minister of Health, November 14, 2010, notes:

•Growing problem of diabetes and emphasized the need to raise public awareness of the disease. •Estimates that 6% of people in Myanmar between the ages of 25 and 70 have diabetes. •14% of urban dwellers (due to food and life style) and 7% of the rural population have the disease. •Important to raise awareness about the symptoms so that people who develop the disease know they should go to the hospital.

20

Year# Men20-79

1,000’s

# Women20-79

1,000’s

# People in RuralSetting1,000’s

# People in UrbanSetting1,000’s

# Peoplewith

diabetes 20-39

1,000’s

# People with

diabetes 40-59

1,000’s

# Peoplewith

diabetes 60-79

1,000’s

# Undiagnosed1,000’s

2012 820.57 956.57 769.00 1,007.64 473.58 862.10 441.45 1,120.30

2030 1,503.7 1,979.10 1,233.92 2,248.35 420.80 1,992.68 1,068.78 ---

21

IDF Diabetes Atlas 5th Edition UPDATE 2012- Country-Myanmar Details

Questions?

22

Contacts: PCC Dennis Brining Suzanne Tolson703-503-8019 804-493-8433 dlbent@aol.com stolson@copper.net

Nina Litton202-499-8854Nina.litton@lc4dp.org

23

Diabetes 101:A Brief Overview

Lions Clubs International IAG Mission

Myanmar, 2013Part II

24

What is Diabetes?

•Diabetes mellitus is a condition that occurs when the body can't use glucose (a type of sugar) normally. Glucose is the main source of energy for the body's cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas. Insulin helps glucose enter the cells.

•In diabetes, the pancreas does not make enough insulin (type 1 diabetes) or the body can't respond normally to the insulin that is made (type 2 diabetes). This causes glucose levels in the blood to rise, leading to symptoms such as increased urination, extreme thirst, and unexplained weight loss to mention a few.

25

• What Happens When We Eat?

26

After eating, most food is turned into blood glucose, the body’s

main source of energy.

In people without diabetes, glucose stays in a healthy range because

Normal Blood Glucose Control

Insulin is released at the right times and in the right amounts Insulin helps

glucose enter cells

In diabetes, blood glucose builds up for several possible reasons…

High Blood Glucose (Hyperglycemia)

Too little insulin is made

Liver releases too much glucose

Cells can’t use insulin well

Symptoms of Hyperglycemia

•Increased thirst•Increased urination•Blurry vision•Feeling tired•Slow healing of cuts or wounds•More frequent infections•Weight loss•Nausea, vomiting and abdominal pain

Hyperglycemia Can Cause Serious Long-Term Problems

•Blindness•Diabetic Retinopathy•Kidney disease•Nerve damage•Heart attack•Stroke•Poor circulation in legs

Amputation

Chronic complications of diabetes

Two Main Types of Diabetes

Pancreas makes too little or no insulin

Type 1 diabetes

Type 2 diabetes

•Cells do not use insulin well (insulin resistance)•Ability for pancreas to make insulin decreases over time

Type 1 Diabetes

•1 in 10 people with diabetes have type 1•Most people are under age 20 when diagnosed•Body can no longer make insulin•Insulin is always needed for treatment

Symptoms of Type 1 Diabetes

•Weight loss•Loss of energy•Increased thirst•Frequent urination•Diabetic ketoacidosis (emergency condition of nausea, vomiting, dehydration, could lead to coma)

Symptoms usually start suddenly

Managing Type 1 Diabetes

•Blood glucose monitoring•Education•Healthy food choices•Physical activity•Insulin

Type 2 Diabetes

•9 in 10 people with diabetes have type 2•Most people are over age 40 when diagnosed, but type 2 is becoming more common younger adults, children and teens•Type 2 is more likely in people who:

•Are overweight•Are non-Caucasian•Have a family history of type 2

Symptoms of Type 2 Diabetes

•Usually subtle or no symptoms in early stages:

•Increased thirst•Increased urination•Feeling tired•Blurred vision•More frequent infections

•Symptoms may be mistaken for other situations or problems•1 in 4 with type 2 aren’t aware they have it

Treatment for Type 2 Diabetes May Change Over a Lifetime

Always Includes:•Education•Healthy eating•Blood glucose monitoring•Physical Activity

May Include:

•Oral Medications•Insulin

Risk Factors for Type 2 Diabetes

•Overweight and obesity•Sedentary lifestyle•Family history of diabetes•History of gestational diabetes•Getting older•Ethnic/racial background:

•African American•Hispanic/Latino•Native American•Asian American

Burden of Diabetes

•The leading cause of:•new blindness among adults•kidney failure •non-traumatic lower-limb amputations

•Increases the risk of heart attack and stroke by 2-4 fold•Mortality rates 2-4 times greater than non-diabetic people of the same age

Source: Centers for Disease Control and Prevention

What is Prediabetes?

•Occurs before type 2 diabetes•Blood glucose levels are higher than normal but not yet diabetes•Most people with pre-diabetes don’t know they have it

Is There Any Good News?

•Yes, we can reduce the chances of developing type 2 diabetes in high-risk people (weight loss, exercise, medications)•Yes, we can reduce the chances of developing diabetes complications through:

•Blood glucose control (diet, monitoring, medication)•Blood pressure control•Cholesterol control•Regular visits to healthcare providers•Early detection and treatment of complications

Preventive Efforts Are Keyo Most of the diabetes costs are due to end-stage

complicationso Investment of resources into early diagnosis,

patient education, prevention and treatments pays off in:

•Longer lives•Increased productivity

o Reduced costs over the long term

o By eliminating common risk factors, such as unhealthy diet, physical inactivity, tobacco use and excessive use of alcohol,

o It is possible to prevent:80% of heart diseases and stroke 80% of Type 2 diabetes over 30% of cancers

Steps to Lower Your Risk of Diabetes Complications

• A1C < 7, which is an estimated average glucose of 154mg/dl• Blood pressure < 130/80• Cholesterol (LDL) < 100, statin therapy for high risk• Get help to quit smoking• Be active• Make healthy food choices• Take care of your feet• Get recommended screenings and early treatment for

complications

More Information

• Email askADA@diabetes.org• Social media information:

•www.Facebook.com/AmericanDiabetesAssociation@AmDiabetesAssn•www.diabetesstopshere.org

• Web:•www.diabetes.org

•www.stopdiabetes.com

---WHO: SEARO Dr. Renu Garg: gargr@searo.who.int www.who.int

---NIH: www.nei.nih.gov ---International Diabetes Foundation www.idf.org

Questions?

45

Contacts: PCC Dennis Brining Suzanne Tolson703-503-8019 804-493-8433 dlbent@aol.com stolson@copper.net

Nina Litton202-499-8854Nina.litton@lc4dp.org

46