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ueda2012 idf between serious pandemic and difficult solution-d.adel
- 1. IDF between serious pandemic and difficult solutions Prof. ADEL A EL-SAYED MD Chair Elect Middle East and North Africa (MENA) Region International Diabetes Federation (IDF) Professor of Internal Medicine Sohag Faculty of Medicine Sohag-EGYPT
- 2. The Story • Man on earth. • His dreams: hunger and hard work. • His achievements: control of food production – leading a comfortable life. • The cost.
- 3. Why diabetes matters The epidemic • Already, 366 million people have diabetes and another 280 millions are at identifiably high risk of developing diabetes. • By 2030 this number is expected to rise to 552 millions with diabetes and an additional 398 million people at high risk. • Three out of four people with diabetes now live in low-and middle-income countries. Over the next 20 years, Africa, Middle East and South-East Asia regions will shoulder the greatest increase in diabetes prevalence.
- 4. Why diabetes matters The epidemic • Even in rich countries, disadvantaged groups such as indigenous people and ethnic minorities, recent migrants and slum dwellers suffer higher rates of diabetes and its complications. • No country, rich or poor, is immune to the epidemic.
- 5. Why diabetes matters Health consequences • Every seven seconds someone somewhere dies from diabetes, accounting for more than four million deaths globally each year. • Tens of millions more suffer disabling and life- threatening complications such as heart attack, stroke, kidney failure, blindness and amputation. • Diabetes is also implicated in, and has negative consequences for certain infectious diseases, other non-communicable diseases (NCDs) and for mental health.
- 6. Why diabetes matters Social and Economic Consequences • Diabetes is not only a health crisis, it is a global social catastrophe. • Governments worldwide are struggling to meet the cost of diabetes care. • Costs to employers and national economies are escalating and every day low-income families are being driven into poverty by loss of earnings due to diabetes and the life-long costs of healthcare.
- 7. The Top 10s (number of people with diabetes)
- 8. The Top 10s (prevalence %)
- 11. Deaths due to diabetes • 4.6 million deaths due to diabetes in 2011 • 8.2% of all- cause mortality • 48% in people under 60
- 12. Healthcare expenditures • USD 465 billion spent on healthcare for diabetes • 11% of all healthcare spending is for diabetes • USD 1,274 is spent on diabetes care per person with diabetes in 2011
- 13. Regional highlights Africa: 78% of people with diabetes are undiagnosed Europe: the highest prevalence of type 1 diabetes in children Middle East and North Africa: 6 of the top 10 countries by diabetes prevalence North America and Caribbean: 1 adult in 10 has diabetes South and Central America: 12.3% of all deaths were due to diabetes South-East Asia: almost one-fifth of the world’s people with diabetes live in just seven countries Western Pacific: 132 million adults have diabetes, the largest number of any region
- 15. Diabetes and Tuberculosis • Focused on the linkages between the two diseases and a review of the evidence • Calculated the attributable cases of tuberculosis to diabetes • Highlights areas where there is a high double burden
- 17. Global Problems Need Global Solutions
- 18. IDF • The International Diabetes Federation (IDF) is an umbrella organisation of over 200 national diabetes associations in over 160 countries. • The Federation has been leading the global diabetes community since 1950. IDF’s mission is to promote diabetes care, prevention and a cure worldwide. • the International Diabetes Federation (IDF) has to do something global.
- 19. The opportunity • “Preventing and treating diabetes is effective and cost effective” (WHO, 2005) • Diabetes and its complications are largely preventable. There are proven, affordable interventions available. • Global and national political and business leaders are increasingly aware of the magnitude and consequences of the diabetes epidemic. • There is growing awareness that investing in diabetes prevention and care brings substantial returns in other disease areas and in productivity and human development
- 20. IDF Initiatives • Three gobal initiatives: 1- UN General Assembly Resolution December 2006. 2- UN High-Level Summit NCD Meeting September 2011-2021. 3- Global Diabetes Plan 2011 – 2021.
- 21. UN General Assembly Resolution • Diabetes is a chronic, debilitating and costly disease associated with severe complications, which poses severe risks for families, Member States and the entire world and serious challenges to the achievement of internationally agreed development goals including the Millennium Development Goals. • Encourages Member States to develop national policies for the prevention, treatment and care of diabetes
- 22. UN SUMMIT ON NCDS • The UN High-Level Summit on Non- Communicable Diseases held on the 19th-20th September 2011 in New York was a major milestone in the history of global health and development. • A record 34 Heads of State and Government attended, and 120 Member States made statements expressing their concern about the global burden of NCDs and committing themselves to action.
- 23. UN SUMMIT ON NCDS • The Political Declaration on NCD Prevention and Control was adopted unanimously at the meeting by 193 Member States. • The Political Declaration includes a set of commitments that firmly position diabetes and NCDs at the top of global and national health and development agendas. • For the first time the world's governments have taken ownership and recognised diabetes and NCDs as a major challenge in the 21st century and Committed to global action on this problem.
- 24. 10 HEADLINE MESSAGES • National leadership and ownership to drive progress • Prioritise early diagnosis and treatment • Prevention must be the cornerstone of the response • Strengthening health systems is of critical importance • Enhance the knowledge base through research and development
- 25. 10 HEADLINE MESSAGES • Additional resources required • Diabetes and NCDs and the global development agenda • Collaborative partnerships with NGOs • Monitoring trends and progress • Partnerships, reports and reviews to drive and monitor follow-up action
- 26. Global Diabetes Plan 2011-2021 • The Global Diabetes Plan was launched in 2011, a milestone year when world leaders met at UN headquarters in New York to agree actions on diabetes and other non-communicable diseases. • The UN High-Level Summit on NCDs was just the start. Work will continue to turn political promises into global action for people who have diabetes now and to reduce the rate of the future development of diabetes and its serious complications.
- 27. The purpose of the Global Diabetes Plan 1. Reframe the debate on diabetes to further political awareness of its causes and consequences and the urgent need for action at the global and country levels. 2. Set out a globally consistent plan to support and guide the efforts of governments, international donors and IDF member associations to combat diabetes. 3. Propose proven interventions, processes and partnership for reducing the personal and societal burden of diabetes. 4. Support and build on existing policies and initiatives such as the WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases. 5. Strengthen the global movement to combat the diabetes epidemic and to improve the health and lives of people with diabetes.
- 28. The objectives 1- Improve health outcomes of people with diabetes: Early diagnosis, cost effective treatment and self-management education. 2- Prevent the development of type 2 diabetes: Lifestyle interventions and socially responsible policies to promote healthy nutrition and physical activity. 3- Stop discrimination against people with diabetes: Supporting legal and policy frameworks and encouraging awareness of diabetics rights campaigns.
- 29. The key strategy Implement National Diabetes Programmes: Which are feasible and desirable for all countries to have, and successful models are already in place in some countries.
- 30. Delivering results - Strengthen institutional frameworks. - Integrate and optimise human resources and health services. through training and workforce development, particularly at primary care level - Review and streamline supply systems: Optimise the provision of essential diabetes medicines and technologies through reliable distribution systems - Generate and use research evidence strategically: apply evidence to policy and practice
- 31. Delivering results - Monitor, evaluate and communicate outcomes: to assess progress. - Allocate appropriate and sustainable domestic and international resources: including Official Development Assistance (ODA) for low-and middle-income countries. - Adopt a whole of society approach: Engage governments, the private sector and civil society (including healthcare workers, academia and people with diabetes) in working together to turn the tide on diabetes.
- 32. Global Diabetes Plan • We already have the evidence. Now, with the Global Diabetes Plan in our hands, we are one step closer to stopping avoidable deaths and reducing the suffering caused by diabetes.
- 33. THANK YOU
Editor's Notes
- New in this edition: China takes the top spot, with India close behind. This is heavily influenced by the new study published in 2010. Our estimates are just under theirs at 90 million (compared to 91 million) and can be attributed to different age groups and a somewhat more conservative approach. Increases and changes in the position of countries relative to each other can be explained mostly by an ageing population and changes in urbanisation. Note, the BRIC countries are all in the top 10. Only the US is a high-income country.
- The Pacific Islands and MENA dominate this category. The rates are more than twice the global average. Changes again only take into account changes in the population structure and urbanisation. For Pacific Islands, urbanisation is 100% so it is just age changes that can be expected. New for this edition: IMPORTANT: Nauru is no longer number 1 This is due not only to new data from the region, but may also reflect the effects of mortality due to diabetes. The emergence of MENA – 6 out of the 10 countries are in MENA
- Biggest changes will be in Africa, followed very closely by MENA. NAC and Europe will change the least.
- We used reports coming from the original population-based studies that tell us what proportion of the prevalence from the study were found to have diabetes at the time of the survey. The vast majority of these are people with type 2 diabetes, but undiagnosed type 1 diabetes is not unheard of, although it is of short duration, generally. In order to provide more accurate estimates for regions, and especially where data were lacking, we decided to create estimates of the proportion of undiagnosed (%) for each region and income group. For all the studies that provided data and had a sufficient quality, we took the median value of all studies within that region and income group. This allowed us to control for the skew of the data rather than if we took the mean. So if one study reported a number that was very different from all the others, it wouldn’t pull our estimate in that direction. Low-income countries in Africa have the highest estimated proportion of undiagnosed diabetes (77.9%) However, for any one region and income group, the proportion of undiagnosed diabetes was at least 27%. This is very high and likely an underestimate. Globally, half of all cases of diabetes are undiagnosed. Over 60% of all people with undiagnosed diabetes are in the Western Pacific and South-East Asia Regions.
- More deaths due to diabetes than HIV/AIDS, malaria, and tuberculosis combined. GENDER There is no difference in the total number of deaths due to DM in men and women. But there are differences in the distributions. Diabetes accounts for a higher proportion in women than in men. This is due mostly to a higher rate of mortality from other causes in men than in women. TRENDS A 13.3% increase over the 4th edition, due mostly to higher prevalence of diabetes in several regions. There has been a documented decline in the deaths due to other NCDs in the world, but no similar decline for diabetes. ACCURACY The estimates use prevalence data combined with the relative risk of death from diabetes by age and region from existing mortality data. It certainly has gaps but is more accurate than that for diabetes from health statistics. This is because those statistics collect data from death reports and diabetes is rarely listed as the cause of death on a certificate, even though it may have been the underlying cause.
- The maps show us countries were there is high spending per person with diabetes, and high total spending on diabetes. The healthcare expenditures measure includes medical spending on diabetes by the health system as well as by people with diabetes. It does not include the indirect costs to society from lost productivity, absences from work, and the associated costs of care. In other words, this is a big underestimate of the true cost of diabetes. It is also important to note that some of this spending is necessary as part of care. However, some studies show that families pay 40-60% of medical care expenditures out of their own pockets for diabetes, which shows a disproportionate amount of the cost is borne by people with diabetes and their caregivers.
- The differences in spending are almost the exact reverse of the mortality and prevalence data. High-income countries have a much higher total spending that any of the middle- or low-income countries. This additional spending is probably contributing to the lower mortality rate, prevalence, and total deaths. In addition, mean spending on diabetes per case is much higher in high-income than in any of the other groups. In low-income, it is almost non-existent.
- Diabetes increases the chances of developing tuberculosis by 2.5 times at least. A person with diabetes and tuberculosis is more likely to fail tuberculosis treatment and more likely to die from tuberculosis than a person without diabetes.
- Using the fact that we know that a person with diabetes has 2.5 times the chances of developing tuberculosis, we can calculate how much tuberculosis in a country may be due to diabetes. We see that for countries with a high burden of diabetes and a relatively low burden of tuberculosis, a large proportion of tuberculosis cases may be attributable to diabetes. Conversely, countries with a low diabetes burden will have fewer tuberculosis cases related to diabetes.