1. Diabetes: The Epidemic of the 21 st Century Professor Jean Claude Mbanya, Professor Nigel Unwin, Dr David Whiting IDF Diabetes Atlas Launch Monday, October 19, 12:30 – 1:30 PM IDF World Diabetes Congress 2009 Montréal, Canada
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6. Diabetes: Epidemic out of control Professor Nigel Unwin Chair of the IDF Diabetes Atlas Committee IDF Diabetes Atlas Launch Monday, October 19, 12:30 – 1:30 PM IDF World Diabetes Congress 2009 Montréal, Canada
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12. The diabetes epidemic is here Diabetes is a threat to social and economic development
13. Diabetes: taking action Dr David Whiting IDF Epidemiologist IDF Diabetes Atlas Launch Monday, October 19, 12:30 – 1:30 PM IDF World Diabetes Congress 2009 Montréal, Canada
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17. Integrated approach MACRO : policy; finance MESO : community; health care organizations MICRO : person with diabetes; family
My name is Jean Claude Mbanya, Incoming President of IDF. Welcome to the 20 th World Diabetes Congress, launch of the 4 th edition of the IDF Diabetes Atlas. Joining me to today to discuss the Atlas findings are Prof Nigel Unwin, who led the team of experts behind this edition of the Diabetes Atlas and Dr David Whiting, IDF’s epidemiologist and a member of the Atlas team.
The data from the latest edition of the IDF Diabetes Atlas show that the epidemic is out of control. We are losing ground in the struggle to contain diabetes. No country is immune and no country is fully equipped to repel this common enemy. The findings in the latest edition of the Diabetes Atlas show that: Epidemic is out of control in spite of earlier warnings by IDF ; shows we have not done enough to curb the epidemic; that it is still growing rapidly Low- and middle-income countries bear the brunt of the epidemic; affecting younger age groups; a serious development issue impeding Millennium Development Goals Urgent need for prevention programmes Severe burden to healthcare systems – have to strengthen healthcare systems to cope with increasing numbers
3 years ago, governments recognized the threat of diabetes by unanimously adopting UN Resolution 61/225. They must now deliver on that political promise. Governments, international organizations, civil society, aid agencies must now build on the pledge of the UN Resolution on diabetes.
IDF is the global voice for diabetes. IDF, through the publication of the IDF Diabetes Atlas, is highlighting the current evidence that governments need to make informed decisions on policy and programmes, identifying areas where action is urgently needed and that can be addressed by the international community. Let me now introduce Professor Unwin who will present the details of the findings.
Hello, my name is Nigel Unwin, I’ve a long standing interest in the global burden of diabetes, and I was asked by Jean Claude to help lead the development of this edition of the Atlas.
It is estimated that in 2010, 285 million adults worldwide will have diabetes. This is approaching 7% of the adult population. It is conservatively estimated (allowing for changing population size, age structures and trends in urbanisation) that by 2030 438 million will have diabetes, almost 8% of the adult population. It is possible that the figure could be much greater. IGT stands for impaired glucose tolerance. People with this condition have blood glucose that is raised, but not quite high enough for a diagnosis of diabetes. IGT is important because people with it are at markedly increased risk of developing diabetes , and also at increased risk of cardiovascular disease. 8% of pop with IGT. Good news, discussed later, is that if people with IGT can modify diet and PA they can dramatically reduce the risk of developing DM – discussed later by David.
IDF Regions and global projections for the number of people with diabetes (20-79 years), 2010-2030
Number of people with diabetes (20-79 years), 2010 and 2030
Prevalence (%) estimates of diabetes (20-79 years) by region, 2010 and 2030
Deaths attributable to diabetes as percentage of all deaths (20-79 years) by region, 2010 Will say a bit about why diabetes contributes to mortality e.g. CVD and renal death, and why routine (including WHO) estimates grossly underestimate mortality. Even in the poorest parts of the world, e.g. SSA, over 1 in 20 deaths due to DM, 1/3 million in 2010.
Human suffering (major cause of visual loss, renal failure, impotence, increased risk of infection, and lower limb amputation) and premature mortality Economic and social costs to families, communities and societies, including costs for health care, loss of earnings, and lost economic development through sickness/premature mortality in working population Although not specifically flagged as part of the Millennium Development Goals, it nonetheless threatens their attainment.
Hello. I am David Whiting, Epidemiologist and Public Health Specialist at the International Diabetes Federation.
There's a couple of important perception problems around diabetes in low- and middle-income countries. The first is that many people think that diabetes is a problem only in high income countries. Nigel has already shown that this is not true. Once people accept that diabetes is a problem in low- and middle-income countries, the second commonly-held perception is that diabetes is too large, too difficult and too expensive to deal with. But with the IDF Diabetes Atlas we (also?) bring some good news: basic care for diabetes does not have to be difficult and does not have to be very expensive. There is now have good evidence to support solutions that range from good basic care for resource-limited settings through to more advanced care where resources allow. There is also good evidence that diabetes can be delayed or prevented and that the solutions are as applicable to low-income settings as they are to higher-income countries. The focus for low- and middle-income countries needs to be on the prevention of diabetes by increasing physical activity and improving diets and on improving the coverage of good quality basic care. We already know in principle what needs to be done and now we need to focus on finding ways to implement what we know.
One area of focus is prevention. We now have robust evidence that type 2 diabetes can be prevented in people who are at high risk of diabetes. Two of the prevention trials that showed this were conducted in the two countries that have the largest numbers of people with diabetes: India and China. The study in China began over 20 years ago and a follow-up study has shown that the beneficial effects of the 6-year intervention have continued after the study period. Indeed, 20 years after the study started, fewer people in the intervention group developed diabetes than in the control group. [Q&A: Need to know details, e.g. number of participants, type of intervention] The interventions in these studies were based on increased physical activity and improved diet. One of the challenges that now remains is to determine the most efficient and effective way to screen for those at high risk. Improving diet and increasing physical activity is also likely to reduce the incidence of diabetes in the general population and a second approach targeted at the general population is also needed. While we have good trial evidence that type 2 diabetes can be delayed or prevented, we currently have limited evidence about how to do this in the general population.
The second area of focus is to improve the coverage of good quality basic care. Care for people with diabetes is often seen as expensive and certainly the data in the IDF Diabetes Atlas underlines the high economic costs of diabetes. Many countries, however, could improve the care provided for people with diabetes cost-effectively by focussing on good quality basic care. In work carried out for the World Bank and World Health Organization interventions were divided into three groups based on their feasibility and cost-effectiveness. The IDF global guideline for type 2 diabetes is also divided in a similar way allowing for the availability of resources. Just improving the coverage of the first group of World Bank/WHO interventions—moderate blood glucose control; moderate blood pressure control and foot care—will make a huge difference in many low- and middle-income countries shown in the IDF Diabetes Atlas to have large numbers of people with diabetes.
Providing good quality diabetes care requires an integrated approach. At the micro level, and at the centre of all care, are the people with diabetes, their families and their immediate carers. At the meso level is the community and healthcare organizations within which care is delivered. At the macro level are the supporting policy and financing frameworks. The World Health Organization’s Innovative Care for Chronic Conditions Framework provides guidance on the relationships between, and the contents of, these three levels. This framework can be used to help repair the fragmentation of health services across the range of needs that people with diabetes have, and to provide links to broader population interventions, such as those for the prevention of diabetes.
So it is possible to provide good basic care based on what we already know about the management and prevention of diabetes. However, what is currently being provided and the action that is being taken is far from what is needed. Simple, cost-effective solutions exist to take on the burgeoning epidemic of diabetes. A small number of essential medicines — most of which are out-of-patent and cost pennies to produce — could save many lives in LMCs. Such action would bring the international community closer to achieving the UN Millennium Development Goals. Governments who invest in prevention now will be spared the overwhelming costs of chronic care later.
So, is it possible to prevent type 2 diabetes and provide good basic care for all with diabetes in low- and middle-income countries? Yes, it is. I would like to leave you with three of the five key messages in the IDF Diabetes Atlas: The majority of type 2 diabetes cases can be prevented — prevention costs governments far less than treating diabetes and its complications. The non-preventable forms of diabetes can be treated — lives can be saved but people in low-and middle-income countries need access to essential diabetes medicines. Diagnosis, treatment, management and prevention of diabetes and other non-communicable diseases require integrated health systems, delivery of care down to primary care level, and supportive policies outside the health sector.
JCM: Thank you David.
As we have just heard, the diabetes epidemic is at our door.
The epidemic represents nothing short of a global health emergency. It is alarming that world leaders stand by while the diabetes fuse slowly burns. The serious impact on families, countries and economies continues with little resistance. Governments, aid agencies and the international community must take concerted action to defuse the threat now, before the diabetes time bomb explodes. To tackle the diabetes epidemic, IDF has forged alliances with the International Union Against Cancer (UICC) and World Heart Federation (WHF) and together call for the international community to: Ensure the availability of essential medicines for people living with NCDs in low- and middle- income countries Immediately and substantially increase financing for NCDs Integrate NCD prevention into national health systems and the global development agenda Create a Special Envoy of the UN Secretary-General for NCDs Support a UN General Assembly Special Session on NCDs
We will give a brief demo of the Atlas CD-rom 2 mins and then open for Q&A
Questions from the floor and from telephones Telephone will be moderated by the operator
