Download What is Diabetes?

Diabetes and How it Is
Affecting Regional and Global
Health with a Focus
on Myanmar
Lions Clubs International
IAG Mission
Myanmar, 2013
Part 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
Diabetes is a Global Problem:
Pilot
Program
• 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.
• Diabetes in the WHO
South East Asia Region:
Dr. Samlee Plianbangchang-WHO Regional
Director, SEARO November 14, 2012
7
•
Estimated proportion of deaths by cause, South-East Asia Region, 2008
Total number of deaths in the Region=14.5 million (Source: WHO global Health
observatory 2011 http://apps.who.int/ghodata/ )
Injuries
10.7%
Cardiovascular diseases
24.9%
Communicable diseases,
mat ernal & perinat al condit ions,
nut rit ional deficiencies
34.7%
Chronic respirat ory
diseases/ast hma
9.6%
Cancers
7.8%
Ot her chronic diseases
10.2%
Diabet es
2.1%
8
•
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/ )
49
50
South-East Asia Region
Rest of the world
40
Percentage
34
31
30
27
23
27
21
20
21
16
14
10
0
All NCD deaths
Cancer deaths
Diabetes
Cause of NCD death
Cardiovascular
deaths
Chronic respiratory
diseases
9
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Number of attributable deaths
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•
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)
1500
1000
500
0
10
Prevalence of Smoking-South East Asia Region 2008 (Source: WHO Global Status
Report on Non-communicable Diseases, 2010)
60
Females
Males
49
There are 250 million smokers and an equal
number of smokeless tobacco users in the
Region
38
40
% of current
daily smokers
33
32
30
22
20
16
9.5
6.8
3.2
1.3
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11
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)
8
7.1
6
4.3
4
2.7
2.4
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0.54
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0.58
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Average Pre Capita Consumption
(Litres)
•
12
Percentage of adults with insufficient physical activity, South-East Asia Region, 2008
(Source: WHO Global Status Report on Non-communicable Diseases, 2010)
45
41
40
Prevalence (%) of Insufficiently Active
•
Females
Males
37
35
33
32
30
28
25
21
20
19
18
17
15
15
17
14
13
10
10
6.6
5
2.7
0
Bangladesh
India
Indonesia
Maldives
Myanmar
Nepal
Sri Lanka
T hailand
13
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)
Females
Males
50
Prevalence (%) of High BP
•
40
42
40
39
37
34
44
42
40
37
36
37
32
30
20
More than a
third of the adult
population is
affected by high
blood pressure
10
0
Bhutan
India
Indonesia
Myanmar
Sri Lanka
Thailand
14
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)
60
Prevalence (%) of Raised Cholesterol
•
56
55
Females
40
Males
38
31
32
33
30
26
20
0
Bhutan
India
Indonesia
Thailand
15
•
Percentage of adult population overweight, South-East Asia Region, 2008 Note:
Overweight=Body mass index≥ 25 kg/m2 (Source: WHO Global Status Report on Noncommunicable Diseases, 2010; prevalence rate adjusted for 2008 based on country reported risk
factor surveillance data)
60
% of population overweight
50
53
Women are more likely to
be overweight
Females
Males
40
37
30
30
24
25
27
25
20
17
16
14
13
10
26
24
10
8.9
7.8 7.6
9.8
0
Bangladesh
Bhutan
India
Indonesia
Maldives
Myanmar
Nepal
Sri Lanka
T hailand
16
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)
12
12
10
Females
Males
13
11 11
9.9
9.3
9.2
9.8
9.3
8.6
8
7.1
7.5
7.8
7.1 7.3
7.1
6.6
6.1
6
4
2
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Prevalence (%) of Raised Fasting Glucose Level
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17
WHO-Number of People with Diabetes in SEAR 2011 (millions)
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
NUMBER OF PEOPLE WITH DIABETES
IN SEAR 2011 (MILLIONS)
18
Diabetes in Myanmar:
• Prevalence of Diabetes
in Lower Myanmar
is 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
• 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
19
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
IDF Diabetes Atlas 5th Edition UPDATE 2012- Country-Myanmar Details
# People
in Urban
Setting
1,000’s
# People
with
diabetes
20-39
1,000’s
# People
with
diabetes
40-59
1,000’s
# People
with
diabetes
60-79
1,000’s
# Undiagnosed
1,000’s
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
---
Year
# Men
20-79
1,000’s
# Women
20-79
1,000’s
# People
in Rural
Setting
1,000’s
2012
820.57
956.57
769.00
21
Questions?
22
Contacts:
PCC Dennis Brining
703-503-8019
[email protected]
Suzanne Tolson
804-493-8433
[email protected]
Nina Litton
202-499-8854
[email protected]
23
Diabetes 101:
A Brief Overview
Lions Clubs International
IAG Mission
Myanmar, 2013
Part 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?
After eating, most food is turned
into blood glucose, the body’s
main source of energy.
26
Normal Blood Glucose Control
In people without diabetes,
glucose stays in a healthy range because
Insulin is
released at
the right
times and in
the right
amounts
Insulin helps
glucose enter
cells
High Blood Glucose (Hyperglycemia)
In diabetes, blood glucose builds up
for several possible reasons…
Too little
insulin is
made
Cells can’t use
insulin well
Liver releases
too much
glucose
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
Chronic complications of diabetes
•Blindness
•Diabetic Retinopathy
•Kidney disease
•Nerve damage
•Heart attack
•Stroke
•Poor circulation in legs
 Amputation
Two Main Types of Diabetes
Type 1 diabetes
Pancreas makes too little or no insulin
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
Symptoms usually start suddenly
•Weight loss
•Loss of energy
•Increased thirst
•Frequent urination
•Diabetic ketoacidosis
(emergency condition
of nausea, vomiting,
dehydration, could lead to
coma)
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 prediabetes 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 Key
o
o
o
Most of the diabetes costs are due to end-stage
complications
Investment of resources into early diagnosis,
patient education, prevention and treatments pays
off in:
•Longer lives
•Increased productivity
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 [email protected]
Social media information:
•www.Facebook.com/AmericanDiabetesAssociation@AmDiabetesAssn
•www.diabetesstopshere.org
Web:
•www.diabetes.org
•www.stopdiabetes.com
---WHO: SEARO
Dr. Renu Garg: [email protected]
www.who.int
---NIH:
www.nei.nih.gov
---International Diabetes Foundation
www.idf.org
Questions?
45
Contacts:
PCC Dennis Brining
703-503-8019
[email protected]
Suzanne Tolson
804-493-8433
[email protected]
Nina Litton
202-499-8854
[email protected]
46