Diabetes- A Major PublicDiabetes- A Major Public
Health ProblemHealth Problem
Dr. Nayyar Raza KazmiDr. Nayyar Raza Kazmi
Diabetes mellitus is a chronicDiabetes mellitus is a chronic
condition that characterised bycondition that characterised b...
• Type 2 diabetes is caused by aType 2 diabetes is caused by a
combination of insulin resistancecombination of insulin res...
• WHO defines Diabetes as Fasting BloodWHO defines Diabetes as Fasting Blood
Glucose more than 126 mg/dL on oneGlucose mor...
Magnitude of the ProblemMagnitude of the Problem
0
50
100
150
200
250
300
millions
1995
2000
2025
• The number ofThe numbe...
WHO estimate: prevalence of diabetes for all age-WHO estimate: prevalence of diabetes for all age-
groups worldwide was es...
• Prevalence in Pakistan approx 4.2%Prevalence in Pakistan approx 4.2%
• Highest in Urban Mohajirs (5.7%,Highest in Urban ...
Why TypeII Diabetis Prevlance isWhy TypeII Diabetis Prevlance is
IncreasingIncreasing
• Aging of the population.Aging of t...
The Cost of DiabetesThe Cost of Diabetes
• Direct costs:Direct costs:
– Direct costs to individuals and their families inc...
The Cost of DiabetesThe Cost of Diabetes
• Indirect costs:Indirect costs:
– Sickness, absence, disability, prematureSickne...
Facts on Prevention DiabetesFacts on Prevention Diabetes
The heavy social and economic costsThe heavy social and economic ...
Facts on Prevention of DiabetesFacts on Prevention of Diabetes
pre-diabetes can prevent thepre-diabetes can prevent the
de...
Facts on Prevention of DiabetesFacts on Prevention of Diabetes
• Primary prevention protectsPrimary prevention protects
su...
Facts on Prevention of DiabetesFacts on Prevention of Diabetes
• Secondary prevention includesSecondary prevention include...
Primary preventionPrimary prevention
Primary prevention
WeightWeight
LossLoss PhysicalPhysical
ActivityActivity
StopStop
S...
Primary preventionPrimary prevention
• Lifestyle Changes Can PreventLifestyle Changes Can Prevent
DiabetesDiabetes
Weight ...
Taking Action to PreventTaking Action to Prevent
DiabetesDiabetes
Change will come more easily ifChange will come more eas...
Major issues to considerMajor issues to consider
• Policy and Advocacy at National levelPolicy and Advocacy at National le...
Weight Loss Is Accompanied by Considerable LoweringWeight Loss Is Accompanied by Considerable Lowering
of the Risk of Diab...
2. Waist Circumference2. Waist Circumference
• The body-mass index does not indicateThe body-mass index does not indicate
...
Treatment of obesity will prevent illnessTreatment of obesity will prevent illness
development in individuals at risk andd...
Physical Activity and DiabetesPhysical Activity and Diabetes
PreventionPrevention
• Physical activity decreases insulinPhy...
Smoking Predisposes to Type 2Smoking Predisposes to Type 2
DiabetesDiabetes
• Studies shown correlation betweenStudies sho...
RecommendationsRecommendations
Change will come more easily ifChange will come more easily if
everyone is involved.everyon...
RecommendationsRecommendations
• The government should work toThe government should work to
reduce health inequality and i...
• Parents of overweight children should beParents of overweight children should be
helped to take responsibility andhelped...
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Diabetes a major public health problem

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Diabetes a major public health problem

  1. 1. Diabetes- A Major PublicDiabetes- A Major Public Health ProblemHealth Problem Dr. Nayyar Raza KazmiDr. Nayyar Raza Kazmi
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 15. Primary preventionPrimary prevention Primary prevention WeightWeight LossLoss PhysicalPhysical ActivityActivity StopStop SmokingSmoking
  16. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.
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