1. Diabetes- A Major PublicDiabetes- A Major Public
Health ProblemHealth Problem
Dr. Nayyar Raza KazmiDr. Nayyar Raza Kazmi

2. Diabetes mellitus is a chronicDiabetes mellitus is a chronic
condition that characterised bycondition that characterised by
raised plasma glucose levels. raised plasma glucose levels.
Diabetes, results from the body’sDiabetes, results from the body’s
inability to produce or use insulininability to produce or use insulin
properly, resulting in high levels ofproperly, resulting in high levels of
blood sugar. blood sugar.

3. • Type 2 diabetes is caused by aType 2 diabetes is caused by a
combination of insulin resistancecombination of insulin resistance
and some degree of insulinand some degree of insulin
deficiency.deficiency.
• Type 1, the body produces noType 1, the body produces no
insulin. More than 80% ofinsulin. More than 80% of
recognised diabetes is Type 2 andrecognised diabetes is Type 2 and
most of the remainder is Type 1.most of the remainder is Type 1.

4. • WHO defines Diabetes as Fasting BloodWHO defines Diabetes as Fasting Blood
Glucose more than 126 mg/dL on oneGlucose more than 126 mg/dL on one
single occasionsingle occasion
OROR
• Random Blood Glucose of 200mg/dL orRandom Blood Glucose of 200mg/dL or
more on 2 and/or more occasions.more on 2 and/or more occasions.

5. Magnitude of the ProblemMagnitude of the Problem
0
50
100
150
200
250
300
millions
1995
2000
2025
• The number ofThe number of
people withpeople with
diabetes willdiabetes will
nearly doublenearly double
within the firstwithin the first
quarter of thisquarter of this
millennium.millennium.
World Health Report, 1997;World Health Report, 1997;
Geneva: WHO.Geneva: WHO.

6. WHO estimate: prevalence of diabetes for all age-WHO estimate: prevalence of diabetes for all age-
groups worldwide was estimated to be 2.8% ingroups 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 inEstimated 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 wasNumber of deaths attributed to diabetes was
previously estimated at just over 800,000.previously estimated at just over 800,000.

7. • 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%)

8. Why TypeII Diabetis Prevlance isWhy TypeII Diabetis Prevlance is
IncreasingIncreasing
• Aging of the population.Aging of the population.
• Increased incidence due toIncreased incidence due to
urbanization especially in theurbanization especially in the
developing countries.developing countries.
– More sedentary lifestyle.More sedentary lifestyle.
– Food consumption patterns, moreFood consumption patterns, more
foods with high fat content and morefoods with high fat content and more
refined carbohydrates.refined carbohydrates.

9. The Cost of DiabetesThe Cost of Diabetes
• Direct costs:Direct costs:
– Direct costs to individuals and their families includeDirect costs to individuals and their families include
medical care, drugs, insulin and other suppliesmedical care, drugs, insulin and other supplies
– Direct costs to the healthcare sector include hospitalDirect costs to the healthcare sector include hospital
services, physician services, …services, physician services, …
– Overall, direct health care costs of diabetes rangeOverall, 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 thedepending on local diabetes prevalence and the
sophistication of the treatment available.sophistication of the treatment available.

10. The Cost of DiabetesThe Cost of Diabetes
• Indirect costs:Indirect costs:
– Sickness, absence, disability, prematureSickness, absence, disability, premature
retirement or premature mortality can causeretirement or premature mortality can cause
loss of productivity.loss of productivity.
– Estimating the cost to society of this loss ofEstimating the cost to society of this loss of
productivity is not easy. Pain, anxiety,productivity is not easy. Pain, anxiety,
inconvenience and other factors whichinconvenience and other factors which
decrease quality of life are intangible costs,decrease quality of life are intangible costs,
which are just as heavy.which are just as heavy.

11. Facts on Prevention DiabetesFacts on Prevention Diabetes
The heavy social and economic costsThe heavy social and economic costs
of type 2 diabetesof 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 primaryand stroke) mean that primary
prevention must be a priority.prevention must be a priority.

12. Facts on Prevention of DiabetesFacts on Prevention of Diabetes
pre-diabetes can prevent thepre-diabetes can prevent the
development of type 2 diabetes bydevelopment of type 2 diabetes by
making changes in their lifestyle.making changes in their lifestyle.
Effective prevention also means moreEffective prevention also means more
cost-effective healthcare.cost-effective healthcare.

13. Facts on Prevention of DiabetesFacts on Prevention of Diabetes
• Primary prevention protectsPrimary prevention protects
susceptible individuals fromsusceptible individuals from
developing diabetes. It has andeveloping diabetes. It has an
impact by reducing or delaying bothimpact by reducing or delaying both
the need for diabetes care and thethe need for diabetes care and the
need to treat diabetesneed to treat diabetes
complications.complications.

14. Facts on Prevention of DiabetesFacts on Prevention of Diabetes
• Secondary prevention includesSecondary prevention includes
early detection, prevention andearly detection, prevention and
treatment. Appropriate action takentreatment. Appropriate action taken
at the right time is beneficial inat the right time is beneficial in
terms of quality of life, and is cost-terms of quality of life, and is cost-
effective, especially if it caneffective, especially if it can
prevent hospital admissionprevent hospital admission

15. Primary preventionPrimary prevention
Primary prevention
WeightWeight
LossLoss PhysicalPhysical
ActivityActivity
StopStop
SmokingSmoking

16. Primary preventionPrimary prevention
• Lifestyle Changes Can PreventLifestyle Changes Can Prevent
DiabetesDiabetes
Weight Loss Is Accompanied byWeight Loss Is Accompanied by
Considerable Lowering of the Risk ofConsiderable Lowering of the Risk of
DiabetesDiabetes
• Physical Activity and DiabetesPhysical Activity and Diabetes
PreventionPrevention
• Smoking Predisposes to Type 2Smoking Predisposes to Type 2
DiabetesDiabetes

17. Taking Action to PreventTaking Action to Prevent
DiabetesDiabetes
Change will come more easily ifChange will come more easily if
everyone is involved.everyone is involved.

18. 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 InformationDiabetes registries and Information
SystemsSystems

19. Weight Loss Is Accompanied by Considerable LoweringWeight Loss Is Accompanied by Considerable Lowering
of the Risk of Diabetesof 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 ofbody weight in kg divided by the square of
body height in meters)body height in meters) The higher the body-The higher the body-
mass index, the higher the morbidity andmass index, the higher the morbidity and
mortality risks become.mortality risks become.
• The risk of diabetes increases 15-fold as theThe risk of diabetes increases 15-fold as the
body-mass index rises from 23 kg/m2 to 35body-mass index rises from 23 kg/m2 to 35
kg/m2.kg/m2.

20. 2. Waist Circumference2. Waist Circumference
• The body-mass index does not indicateThe body-mass index does not indicate
the distribution of body fat, and waistthe distribution of body fat, and waist
circumference is therefore also used as acircumference is therefore also used as a
measure of obesity and the associatedmeasure of obesity and the associated
health risks.health risks.

21. Treatment of obesity will prevent illnessTreatment of obesity will prevent illness
development in individuals at risk anddevelopment in individuals at risk and
improve quality of life and prevent lateimprove quality of life and prevent late
complications in those alreadycomplications in those already
affected.affected.
In recent years, attention has beenIn recent years, attention has been
increasingly focused on the incidenceincreasingly focused on the incidence
of central obesity which has beenof central obesity which has been
found to strongly predict risks of typefound to strongly predict risks of type
2 diabetes and metabolic syndrome.2 diabetes and metabolic syndrome.

22. Physical Activity and DiabetesPhysical Activity and Diabetes
PreventionPrevention
• Physical activity decreases insulinPhysical activity decreases insulin
resistance and can aid in both preventingresistance and can aid in both preventing
type 2 diabetes mellitus and managingtype 2 diabetes mellitus and managing
the disease.the disease.
• Physical activity has an insulin-like effectPhysical activity has an insulin-like effect
-- it can help lower blood sugar levels.-- it can help lower blood sugar levels.
• Epidemiological studies suggest thatEpidemiological studies suggest that
physical activity can reduce the risk ofphysical activity can reduce the risk of
non-insulin-dependent diabetes by up tonon-insulin-dependent diabetes by up to
50 percent.50 percent.

23. Smoking Predisposes to Type 2Smoking Predisposes to Type 2
DiabetesDiabetes
• Studies shown correlation betweenStudies shown correlation between
smoking and the risk of developingsmoking and the risk of developing
type 2 diabetes.type 2 diabetes.
– The risk is dose-dependent: the longerThe risk is dose-dependent: the longer
you smoke, the higher the risk.you smoke, the higher the risk.

24. RecommendationsRecommendations
Change will come more easily ifChange will come more easily if
everyone is involved.everyone is involved.
• prevention diabetes can be onprevention diabetes can be on
different levels; individuals,different levels; individuals,
community, local government andcommunity, local government and
national levelsnational levels ..

25. RecommendationsRecommendations
• The government should work toThe government should work to
reduce health inequality and improvereduce health inequality and improve
the environment factor by improvingthe environment factor by improving
the deprived areas and controllingthe deprived areas and controlling
safety and making the streets safe forsafety and making the streets safe for
walking or cycling to school or thewalking or cycling to school or the
workplace, promoting and improvingworkplace, promoting and improving
access to sport and leisure facilities,access to sport and leisure facilities,
as well as encouraging physicalas well as encouraging physical
activityactivity

26. • Parents of overweight children should beParents of overweight children should be
helped to take responsibility andhelped to take responsibility and
encourage healthy eating and physicalencourage healthy eating and physical
activity.activity.
• Anti- smoking behaviour should beAnti- smoking behaviour should be
promoted by implementing legal action.promoted by implementing legal action.